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Reidy JA, Chan SH, Boelitz KM, Chavez M, Clark MA, Epstein SK, Gosline A, Healy R, Livne E, Peirce H, Schaefer KG, Streid J, Vesel T, Young ME, Zehm A, Garg PS. A Call to Action: Using Curriculum Mapping at Four Medical Schools in Massachusetts to Advance Serious Illness Communication Training in Undergraduate Medical Education. J Palliat Med 2024; 27:39-46. [PMID: 37976143 DOI: 10.1089/jpm.2022.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: Practicing physicians require serious illness communication (SIC) skills to ensure high-quality, humanistic care for patients and families as they face life-changing medical decisions. However, a majority of U.S. medical schools do not require formal training in SIC and fail to provide students deliberate practice before graduation. The Massachusetts Medical Schools' Collaborative was created to ensure that students receive foundational SIC training in undergraduate medical education. This Collaborative developed a curriculum-mapping tool to assess SIC at four medical schools. Objective: We aimed to understand existing educational activities across four medical schools and identify opportunities to build longitudinal, developmentally based curricular threads in SIC. Design: From July 2019 to April 2021, faculty, staff, and medical students assessed current educational activities related to five core competencies in SIC, adapted for students from national competencies for palliative medicine fellows, using a curriculum mapping tool. Measurements: The group selected 23 keywords and collected metrics to describe the timing, instruction and assessment for each school's educational activities. Results: On average, there were only 40 hours of required curricula in SIC over four years. Over 80% of relevant SIC hours occurred as elective experiences, mostly during the postclerkship phase, with limited capacity in these elective experiences. Only one school had SIC educational activities during the clerkship phase when students are developing clinical competencies. Assessment methods focused on student participation, and no school-assessed clinical performance in the clerkship or postclerkship phase. Conclusions: Medical schools are failing to consistently train and ensure basic competency in effective, compassionate SIC. Curriculum mapping allows schools to evaluate their current state on a particular topic such as SIC, ensure proper assessment, and evaluate curricular changes over time. Through the deliberate inclusion of SIC competencies in longitudinal curriculum design, we can fill this training gap and create best practices in undergraduate medical education.
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Affiliation(s)
- Jennifer A Reidy
- UMass Memorial Medical Health Care, Division of Palliative Care, Worcester, Massachusetts, USA
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Stephanie H Chan
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts, USA
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA
| | - Kris M Boelitz
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Melissa Chavez
- Boston Medical Center, Departments of Neurology and Otolaryngology, Boston, Massachusetts, USA
| | - Melissa A Clark
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
- Brown University School of Public Health, Department of Health Services, Policy and Practice, Providence, Rhode Island, USA
| | - Scott K Epstein
- Tufts University School of Medicine, Department of Medicine, Boston, Massachusetts, USA
| | - Anna Gosline
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts, USA
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA
| | - Rose Healy
- Boston Medical Center, Departments of Neurology and Otolaryngology, Boston, Massachusetts, USA
| | - Emma Livne
- Hasbro Children's Hospital, Department of Pediatrics, Providence, Rhode Island, USA
| | - Hayden Peirce
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Kristen G Schaefer
- Care Dimensions, Inc., Danvers, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
| | - Jocelyn Streid
- Brigham and Women's Hospital, Department of Anesthesiology, Boston, Massachusetts, USA
| | - Tamara Vesel
- Tufts University School of Medicine, Department of Medicine, Boston, Massachusetts, USA
- Tufts Medical Center, Division of Palliative Care, Boston, Massachusetts, USA
| | - Megan E Young
- Boston University School of Medicine, Departments of Medicine and Pediatrics, Boston, Massachusetts, USA
| | - April Zehm
- Medical College of Wisconsin, Department of Medicine, Milwaukee, Wisconsin, USA
| | - Priya S Garg
- Boston University School of Medicine, Departments of Medicine and Pediatrics, Boston, Massachusetts, USA
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Prasanna SAS, Abeysena HTCS, Alagiyawanna MAAP. Development and validation of the interpersonal communication assessment tool for assessing the interpersonal communication skills of public health midwives. BMC Health Serv Res 2023; 23:539. [PMID: 37226213 DOI: 10.1186/s12913-023-09511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Interpersonal Communication Skills (IPCS) are one of the core clinical skills that should be developed by the Public Health Midwives (PHMs), who are grass-root level public healthcare providers in primary healthcare settings in Sri Lanka. This study aimed to develop and validate the Interpersonal Communication Assessment Tool (IPCAT), an observational rating scale, to assess the IPCS of PHMs. METHODS Item generation, item reduction, instrument drafting, and development of the tool's rating guide were made by an expert panel. A cross-sectional study was conducted in five randomly selected Medical Officer of Health (MOH) areas, the smallest public health administrative division in the district of Colombo, Sri Lanka, to identify the factor structure, which is the correlational relationship between a number of variables in the tool. A sample of 164 PHMs was recruited. The data on IPCS were collected by video-recording the provider-client interaction using simulated clients. All recorded videos were rated by a rater using the drafted IPCAT, which included a Likert scale of 1(poor) to 5 (excellent). Exploratory factor analysis was conducted using the Principal Axis Factoring extraction method and the Varimax rotation technique to explore the factors. Three independent raters were used to rate ten randomly selected videos to assess the tool's internal consistency and inter-rater reliability. RESULTS The IPCAT obtained a five-factor model with 22 items, and all five factors explained 65% of the total variance. The resulting factors were "Engaging" (six items on making rapport), "Delivering" (four items on paying respect), "Questioning" (four items on asking questions), "Responding" (four items on empathy), and "Ending" (four items to assess the skills of ending a conversation productively). The internal consistency, Cronbach's Alpha value, for all five factors was above 0.8, and the inter-rater reliability (ICC) was excellent (0.95). CONCLUSIONS The Interpersonal Communication Assessment Tool is a valid and reliable tool for assessing the interpersonal communication skills of Public Health Midwives. TRIAL REGISTRATION Clinical Trial Registry, Sri Lanka. Ref No, SLCTR/2020/006(February 4th,2020).
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Affiliation(s)
| | - H T C S Abeysena
- Department of Community Medicine, Faculty of Medicine, University of Kelaniya, Gampaha, Sri Lanka
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Damps M, Gajda M, Kowalska M, Kucewicz-Czech E. Limitation of Futile Therapy in the Opinion of Nursing Staff Employed in Polish Hospitals-Results of a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16975. [PMID: 36554855 PMCID: PMC9778965 DOI: 10.3390/ijerph192416975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The debate on limiting futile therapy in the aspect of End of Life (EoL) care has been going on in Poland over the last decade. The growing demand for EoL care resulting from the aging of societies corresponds to the expectation of a satisfactory quality of life and self-determination. The authors designed a cross-sectional study using a newly designed questionnaire to assess the opinions of 190 nurses employed in intensive care units (ICUs) on futile therapy, practices, and the respondents' approach to the issue. The problem of futile therapy and its clinical implications are known to the nursing community. Among the most common reasons for undertaking futile therapy in adult patients, the respondents declared fear of legal liability for not taking such actions (71.58%), as well as fear of being accused of unethical conduct (56.32%), and fear of talking to the patient/patient's family and their reaction (43.16%). In the case of adult patients, the respondents believed that discontinuation of futile therapy should be decided by the patient (84.21%), followed by a doctor (64.21%). As for paediatric patients, two-thirds of the respondents mentioned a doctor and a court (64.74% and 64.21%, respectively). Overall, 65.26% of the respondents believe and agree that the comfort of the patient's last days is more important than the persistent continuation of therapy and prolonging life at all costs. The presented results clearly show the attitude of the respondents who defend the patient's dignity and autonomy.
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Affiliation(s)
- Maria Damps
- Department of Anaesthesiology and Intensive Care, Upper Silesian Child Health Centre, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 16, 40-752 Katowice, Poland
| | - Maksymilian Gajda
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Malgorzata Kowalska
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Ewa Kucewicz-Czech
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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Meyer BD, Fearnow B, Smith HL, Morgan SG, Quinonez RB. Implementing Standardized Patient Caregivers to Practice Difficult Conversations in a Pediatric Dentistry Course. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11201. [PMID: 35036525 PMCID: PMC8720916 DOI: 10.15766/mep_2374-8265.11201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Standardized patient (SP) methodology has been used in health professional education to help students develop communication, deeper diagnostic reasoning, and critical thinking skills. Few examples demonstrate the use of SPs to practice difficult conversations with pediatric caregivers in the pediatric dentistry literature. The objective of this educational activity was to describe the implementation of three SPs in a pediatric dentistry course for second-year dental students. METHODS We developed three SP encounters covering interactions with caregivers of an infant with severe early childhood caries, an adolescent on the path to gender affirmation, and a child with autism and dental caries whose caregiver was resistant to fluoride- and silver-containing dental materials. We describe the case design process, rubric construction and calibration, student debriefing, and pandemic modifications. We evaluated the effectiveness of the implementation by thematic analysis of student reflections following each encounter using a qualitative descriptive framework. RESULTS Eighty-three students completed each encounter. Qualitative analysis showed that students preferred a more realistic encounter by having a child or other distraction present. Students relied on different elements of motivational interviewing depending on the objective of each encounter and the age of the patient. Overall, the SP encounters were well received by students and faculty as an alternative or supplement to traditional student evaluation methods. DISCUSSION We noted a number of lessons learned about implementing SP methodology in pediatric dental education. With these experiences now in place, future evaluations should measure student performance in the SP encounters against student performance during clinical care.
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Affiliation(s)
- Beau D. Meyer
- Assistant Professor, Division of Pediatric Dentistry, The Ohio State University College of Dentistry
- Corresponding author:
| | - Bethany Fearnow
- Curriculum Innovation Consultant, Academic Affairs, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Hannah L. Smith
- Fourth-Year Dental Student, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Sarah G. Morgan
- Fourth-Year Dental Student, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Rocio B. Quinonez
- Professor, Division of Pediatric and Public Health, and Associate Dean for Educational Leadership and Innovation, Academic Affairs, University of North Carolina at Chapel Hill Adams School of Dentistry
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Using Standardized Patients to Augment Communication Skills and Self-Efficacy in Caring for Transgender Youth. Acad Pediatr 2021; 21:1441-1448. [PMID: 34022426 DOI: 10.1016/j.acap.2021.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the impact of standardized patient encounters (SPEs) on gender-affirming communication skills and self-efficacy of pediatrics learners. METHODS Fourth-year medical students, pediatrics interns, psychiatry interns, and nurse practitioner trainees on 1-month adolescent medicine blocks completed a curriculum with e-learning activities that was expanded to include SPEs. Following e-learning, learners completed 2 SPEs featuring transgender adolescent cases. Faculty observers and standardized patients completed checklists focused on history-taking, counseling, and interpersonal communication, and provided learner feedback after each case. The curriculum was evaluated by comparing skills checklists scores from case 1 to case 2 via Wilcoxon signed-rank tests. Self-efficacy was assessed precurriculum (Assessment 1), post-e-learning (Assessment 2), and post-SPE (Assessment 3) using a previously developed instrument. Changes in self-efficacy scores were assessed via linear regression models with generalized estimating equations. RESULTS Forty-three eligible learners participated in the study. The majority were pediatrics interns, and 5 learners had worked in a transgender clinic prior to the curriculum participation. Learners increased median total checklist scores between cases from 22 to 28 (P < .001) (maximum score of 34). Learners' overall self-efficacy scores improved by 3.4 (confidence interval [CI]: 2.9-3.9; P < .001) between Assessments 1 and 2 and by 1.5 (CI: 1.2-1.7; P < .001) from Assessment 2 to 3. Similar improvements in checklist scores and self-efficacy occurred within stratified learner types. CONCLUSIONS The combination of SPEs with e-learning is effective at improving self-efficacy and gender-affirming communication skills for a multidisciplinary pediatrics learners. The comprehensive curriculum allowed learners inexperienced with transgender youth to apply knowledge and practice skills.
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Wubben N, van den Boogaard M, van der Hoeven JG, Zegers M. Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study. BMJ Open 2021; 11:e050134. [PMID: 34380728 PMCID: PMC8359489 DOI: 10.1136/bmjopen-2021-050134] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members. DESIGN Qualitative study. SETTING Two Dutch tertiary centres. PARTICIPANTS 19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay. RESULTS Three themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family. CONCLUSIONS Interviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients' values and needs in the decision-making process.
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Affiliation(s)
- Nina Wubben
- Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | | | - Marieke Zegers
- Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
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Suematsu M, Takahashi N, Okazaki K, Fuchita E, Yoshimi A, Hanya M, Noda Y, Abe K, Kuzuya M. A novel online interprofessional education with standardised family members in the COVID-19 period. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2021; 12:36-37. [PMID: 33772529 PMCID: PMC8411341 DOI: 10.5116/ijme.6043.8be0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Mina Suematsu
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Takahashi
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kentaro Okazaki
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Etsuko Fuchita
- Department of Integrated Health Sciences, Gerontological Nursing, Nagoya University Graduate School of Medicine, Japan
| | - Akira Yoshimi
- Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University, Nagoya, Japan
| | - Manako Hanya
- Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Yukihiro Noda
- Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University, Nagoya, Japan
| | - Keiko Abe
- Clinical Nursing, Aichi Medical University College of Nursing, Nagakute, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Japan
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Utilization of an Online Education Module and Standardized Patient Simulation Experience to Improve Nursing Student Learning Outcomes With Heart Failure Patients. Nurs Educ Perspect 2021; 43:178-180. [PMID: 33660684 DOI: 10.1097/01.nep.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The aim of this experimental study was to examine whether nursing students' participation in an online comprehensive heart failure educational module enhances their knowledge and ability to apply heart failure education skills in a simulated standardized nurse-patient interaction. Findings suggest that students who received a heart failure educational module scored significantly higher on both an exam of heart failure knowledge and a simulated nurse-patient interaction. The results suggest that large gains can be made in nursing education by using innovative teaching strategies that move beyond normal classroom/lecture teaching techniques.
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Gilligan C, Powell M, Lynagh MC, Ward BM, Lonsdale C, Harvey P, James EL, Rich D, Dewi SP, Nepal S, Croft HA, Silverman J. Interventions for improving medical students' interpersonal communication in medical consultations. Cochrane Database Syst Rev 2021; 2:CD012418. [PMID: 33559127 PMCID: PMC8094582 DOI: 10.1002/14651858.cd012418.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence). Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported. AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.
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Affiliation(s)
- Conor Gilligan
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Martine Powell
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, Brisbane, Australia
| | - Marita C Lynagh
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | | | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australia
| | - Pam Harvey
- School of Rural Health, Monash University, Bendigo, Australia
| | - Erica L James
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Dominique Rich
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sari P Dewi
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Smriti Nepal
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Darlington, Australia
| | - Hayley A Croft
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
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Zimmer MA. Evaluation of the Psychometric Properties of Relational Insights 360 Among Baccalaureate Nursing Students With the Use of Standardized Patients. J Nurs Meas 2020; 28:615-632. [PMID: 33199477 DOI: 10.1891/jnm-d-19-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate reliability and validity of the relational competency assessment instrument, Relational Insights 360 (RI-360) (Koloroutis & Trout, 2012), among 104 baccalaureate nursing students and 10 standardized patients (SPs) upon completion of a communication simulation. METHODS The reliability of the RI-360 was determined by Cronbach's alpha coefficient. Interrater reliability of the RI-360 was measured between the SPs and the primary investigator with percentages. Factor analysis was run to evaluate the construct validity. RESULTS The RI-360 was internally consistent with an alpha coefficient of 0.93. Interrater reliability for all items on the RI-360 was 42% between students' scores and SPs' scores and 38.9% between the Primary Investigator's scores and SPs' scores. Exploratory factor analysis showed that factor loadings ranged from 0.29 to 0.84. CONCLUSIONS The RI-360 appears to be a valid and reliable scale for use in measuring relational competency among nursing students and SPs.
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Affiliation(s)
- Mary Ann Zimmer
- Drexel University, College of Nursing and Health Professions, Philadelphia, PA .,M. Louise Fitzpatrick College of Nursing, Villanova, PA
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Morris NA, Czeisler BM, Sarwal A. Simulation in Neurocritical Care: Past, Present, and Future. Neurocrit Care 2020; 30:522-533. [PMID: 30361865 DOI: 10.1007/s12028-018-0629-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Simulation-based medical education is a technique that leverages adult learning theory to train healthcare professionals by recreating real-world scenarios in an interactive way. It allows learners to emotionally engage in the assessment and management of critically ill patients without putting patients at risk. Learners are encouraged to work at the edge of their expertise to promote growth and are provided with feedback to nurture development. Thus, the training is targeted to the learner, not the patient. Despite its origins as a teaching tool for neurological diseases, simulation-based medical education has been historically abandoned by neurocritical care educators. In contrast, other critical care educators have embraced the technique and built an impressive foundation of literature supporting its use. Slowly, neurocritical care educators have started experimenting with simulation-based medical education and sharing their results. In this review, we will investigate the historical origins of simulation in the neurosciences, the conceptual framework supporting the technique, current applications, and future directions.
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Affiliation(s)
- Nicholas A Morris
- Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA. .,Division of Neurocritical Care and Emergency Neurology, University of Maryland Medical Center, 22 S. Greene St, G7K18, Baltimore, MD, 21201, USA.
| | - Barry M Czeisler
- Departments of Neurology and Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Aarti Sarwal
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Nussbaum SE, Oyola S, Egan M, Baron A, Wackman S, Williams S, Benson J, Limaye S, Levine S. Incorporating Older Adults as "Trained Patients" to Teach Advance Care Planning to Third-Year Medical Students. Am J Hosp Palliat Care 2019; 36:608-615. [PMID: 30909719 DOI: 10.1177/1049909119836394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training. OBJECTIVE We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home. DESIGN Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills. SETTINGS AND PARTICIPANTS A total of 223 US MS3s participated in the curriculum. RESULTS Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains ( P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations. CONCLUSIONS The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.
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Affiliation(s)
- Sarah E Nussbaum
- 1 Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Sonia Oyola
- 2 Department of Family Medicine, University of Chicago, Chicago, IL, USA
| | - Mari Egan
- 3 Presence Saint Mary's and Elizabeth Medical Center, Chicago, IL, USA
| | - Aliza Baron
- 4 Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Shewanna Wackman
- 2 Department of Family Medicine, University of Chicago, Chicago, IL, USA
| | - Shellie Williams
- 4 Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Janice Benson
- 5 NorthShore University Health System, Evanston, IL, USA
| | - Seema Limaye
- 6 Edward Hines Jr. Veterans Administration Hospital, Maywood, IL, USA
| | - Stacie Levine
- 4 Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
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Hadley DE, Packel L, Kim H, Darrah NJ, LaMarra D, Bradway C. Faculty facilitators' and standardized family members (SFMs) perceptions of student teamwork during an interprofessional education simulation workshop. J Interprof Care 2018; 32:786-789. [PMID: 30136912 DOI: 10.1080/13561820.2018.1509845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Standardized patients can be trained to portray standardized family members (SFMs) for interprofessional education (IPE) initiatives to maximize student learning. To date, studies of IPE often focus on student learning outcomes rather than on the feedback and perspectives of SFMs and faculty facilitators (FFs), The purpose of our study was to examine SFMs' and FFs' perspectives immediately after participating in an IPE workshop. SFMs and FFs completed a semi-structured questionnaire consisting of open-ended questions to identify positive and challenging aspects of interactions with health professions students during an IPE workshop. A directed content analysis approach was used to assess written feedback (N = 29) from SFMs and FFs. Study findings highlight many similar themes between SFMs and FFs as well as minor differences regarding recognition of emotion and communication transitions. SFMs and FFs both agreed, however, that these are areas for further development by students to improve communication. Our study adds insight into SFMs' and FFs' feedback immediately after an IPE workshop.
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Affiliation(s)
- Diane E Hadley
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy at University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Lora Packel
- Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Hyejin Kim
- Center for Nursing Excellence in Palliative Care, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | - Neha J Darrah
- Department of Medicine, Cedars Sinai, Los Angeles, California, USA
| | - Denise LaMarra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Bradway
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Razai MS. Communicating with patients' families and relatives: Do we need more training? MEDICAL TEACHER 2018; 40:870. [PMID: 29265991 DOI: 10.1080/0142159x.2017.1417581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Mohammad S Razai
- a Department of Primary Care , St George's University Hospital , London , UK
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15
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Myers J, Cosby R, Gzik D, Harle I, Harrold D, Incardona N, Walton T. Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review. Am J Hosp Palliat Care 2018. [PMID: 29529884 DOI: 10.1177/1049909118760303] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. AIM To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. DATA SOURCES A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. CONCLUSIONS Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.
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Affiliation(s)
- Jeff Myers
- 1 Sinai-Bridgepoint Palliative Care Unit, Toronto, Ontario, Canada
| | - Roxanne Cosby
- 2 Program in Evidence-Based Care, McMaster University, Hamilton, Canada
| | - Danusia Gzik
- 3 North Simcoe Muskoka Regional Cancer Program, Cancer Care Ontario, Barrie, Canada
| | - Ingrid Harle
- 4 Department of Medicine, Queen's University, Kingston, Canada.,5 Department of Oncology, Queen's University, Kingston, Canada
| | - Deb Harrold
- 3 North Simcoe Muskoka Regional Cancer Program, Cancer Care Ontario, Barrie, Canada
| | - Nadia Incardona
- 6 Michael Garron Hospital, Toronto East Health Network, Ontario, Canada.,7 Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Tara Walton
- 8 Ontario Palliative Care Network Secretariat, Toronto, Canada
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Kaplonyi J, Bowles KA, Nestel D, Kiegaldie D, Maloney S, Haines T, Williams C. Understanding the impact of simulated patients on health care learners' communication skills: a systematic review. MEDICAL EDUCATION 2017; 51:1209-1219. [PMID: 28833360 DOI: 10.1111/medu.13387] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/18/2017] [Accepted: 05/31/2017] [Indexed: 05/07/2023]
Abstract
CONTEXT Effective communication skills are at the core of good health care. Simulated patients (SPs) are increasingly engaged as an interactive means of teaching, applying and practising communication skills with immediate feedback. There is a large body of research into the use of manikin-based simulation but a gap exists in the body of research on the effectiveness of SP-based education to teach communication skills that impact patient outcomes. The aim of this systematic review was to critically analyse the existing research, investigating whether SP-based communication skills training improves learner-patient communication, how communication skill improvement is measured, and who measures these improvements. METHODS The databases Medline, ProQuest (Health & Medical Complete, Nursing and Allied Health Source) and CINAHL (EBSCOhost) Education Resources Information Centre (ERIC) were searched for articles that investigated the effects of SP-based education on the communication skills of medical, nursing and allied health learners. RESULTS There were 60 studies included in the review. Only two studies reported direct patient outcomes, one reporting some negative impact, and no studies included an economic analysis. Many studies reported statistically significant third-party ratings of improved communication effectiveness following SP-based education; however, studies were unable to be pooled for meta-analysis because of the outcome collection methods. There were a small number of studies comparing SP with no training at all and there were no differences between communication skills, contradicting the results from studies reporting benefits. Of the 60 studies included for analysis, 54 (90%) met the minimum quality score of 7/11, with four articles (7%) scoring 11/11. CONCLUSION SP-based education is widely accepted as a valuable and effective means of teaching communication skills but there is limited evidence of how this translates to patient outcomes and no indication of economic benefit for this type of training over another method.
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Affiliation(s)
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Debra Nestel
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Debra Kiegaldie
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute and Healthscope Hospitals, Moorabbin, Victoria, Australia
| | - Stephen Maloney
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Terry Haines
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Cylie Williams
- Peninsula Health, Allied Health, Frankston, Victoria, Australia
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
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17
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Humanization in healthcare arises from the need for a holistic approach to illness. Med Intensiva 2017; 42:99-109. [PMID: 29132912 DOI: 10.1016/j.medin.2017.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 11/21/2022]
Abstract
Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments.
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18
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Bruce CR, Newell AD, Brewer JH, Timme DO, Cherry E, Moore J, Carrettin J, Landeck E, Axline R, Millette A, Taylor R, Downey A, Uddin F, Gotur D, Masud F, Zhukovsky DS. Developing and testing a comprehensive tool to assess family meetings: Empirical distinctions between high- and low-quality meetings. J Crit Care 2017; 42:223-230. [PMID: 28780489 DOI: 10.1016/j.jcrc.2017.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The heterogeneity with regard to findings on family meetings (or conferences) suggests a need to better understand factors that influence family meetings. While earlier studies have explored frequency or timing of family meetings, little is known about how factors (such as what is said during meetings, how it is said, and by whom) influence family meeting quality. OBJECTIVES (1) To develop an evaluation tool to assess family meetings (Phase 1); (2) to identify factors that influence meeting quality by evaluating 34 family meetings (Phase 2). MATERIALS AND METHODS For Phase 1, methods included developing a framework, cognitive testing, and finalizing the evaluation tool. The tool consisted of Facilitator Characteristics (i.e., gender, experience, and specialty of the person leading the meeting), and 22 items across 6 Meeting Elements (i.e., Introductions, Information Exchanges, Decisions, Closings, Communication Styles, and Emotional Support) and sub-elements. For Phase 2, methods included training evaluators, assessing family meetings, and analyzing data. We used Spearman's rank-order correlations to calculate meeting quality. Qualitative techniques were used to analyze free-text. RESULTS No Facilitator Characteristic had a significant correlation with meeting quality. Sub-elements related to communication style and emotional support most strongly correlated with high-quality family meetings, as well as whether "next steps" were outlined (89.66%) and whether "family understanding" was elicited (86.21%). We also found a significant and strong positive association between overall proportion scores and evaluators' ratings (rs=0.731, p<0.001). CONCLUSIONS We filled a gap by developing an evaluation tool to assess family meetings, and we identified how what is said during meetings impacts quality.
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Affiliation(s)
- Courtenay R Bruce
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA; Houston Methodist System, Bioethics Program, Houston, TX, USA.
| | - Alana D Newell
- Center for Educational Outreach, Baylor College of Medicine, Houston, TX, USA
| | | | - Divina O Timme
- Texas A&M University, College of Medicine, Bryan, TX, USA
| | - Evan Cherry
- Texas A&M University, College of Medicine, Bryan, TX, USA
| | - Justine Moore
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Jennifer Carrettin
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Emily Landeck
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Rebecca Axline
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Allison Millette
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Ruth Taylor
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Andrea Downey
- Division of Supportive and Palliative Care, Houston Methodist Hospital, Houston, TX, USA
| | - Faisal Uddin
- Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX, USA
| | - Deepa Gotur
- Weill Cornell Medical College, New York, NY, USA; Critical Care Division, Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Faisal Masud
- Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX, USA
| | - Donna S Zhukovsky
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Downar J, McNaughton N, Abdelhalim T, Wong N, Lapointe-Shaw L, Seccareccia D, Miller K, Dev S, Ridley J, Lee C, Richardson L, McDonald-Blumer H, Knickle K. Standardized patient simulation versus didactic teaching alone for improving residents' communication skills when discussing goals of care and resuscitation: A randomized controlled trial. Palliat Med 2017; 31:130-139. [PMID: 27307057 DOI: 10.1177/0269216316652278] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Communication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care. OBJECTIVE To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care. DESIGN AND INTERVENTION Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone. PARTICIPANTS First-year internal medicine residents. MAIN MEASURES Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure. KEY RESULTS We enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop ( p = 0.79). The intervention group showed a significant increase in Consultation and Relational Empathy scores post-workshop compared with pre-workshop (35.0 vs 31.7, respectively; p = 0.048), whereas there was no improvement in Consultation and Relational Empathy scores in the control group (35.6 vs 36.0; p = 0.4). However, when the results were adjusted for baseline differences in Consultation and Relational Empathy scores in a multivariable regression analysis, group assignment was not associated with an improvement in Consultation and Relational Empathy score. Improvement in comfort scores and perception of benefit were not associated with improvements in Consultation and Relational Empathy scores. CONCLUSION Simulation training may improve communication skill and comfort more than didactic training alone, but there were important confounders in this study and further studies are needed to determine whether simulation is better than didactic training for this purpose.
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Affiliation(s)
- James Downar
- 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.,2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nancy McNaughton
- 3 Standardized Patient Program, University of Toronto, Toronto, ON, Canada
| | - Tarek Abdelhalim
- 4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Natalie Wong
- 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.,4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lauren Lapointe-Shaw
- 4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dori Seccareccia
- 2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kim Miller
- 5 Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Shelly Dev
- 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Julia Ridley
- 2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christie Lee
- 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Lisa Richardson
- 4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Heather McDonald-Blumer
- 4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kerry Knickle
- 3 Standardized Patient Program, University of Toronto, Toronto, ON, Canada
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Thomas LA, Trello-Rishel JK. Using a Grading Rubric to Address Grading Discrepancies Across Training Sites in the Psychiatry Clerkship. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:151-153. [PMID: 27796966 DOI: 10.1007/s40596-016-0621-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Lia A Thomas
- UT Southwestern Medical Center School of Medicine, Dallas, TX, USA.
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21
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The Impact of Resident Training on Communication with Families in the Intensive Care Unit. Resident and Family Outcomes. Ann Am Thorac Soc 2017; 13:512-21. [PMID: 26989925 DOI: 10.1513/annalsats.201508-495oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE In high-acuity settings such as intensive care units (ICUs), the quality of communication with patients' families is a particularly important component of care. Evidence shows that ICU communication is often inadequate and can negatively impact family outcomes. OBJECTIVES To assess the impact of a communication training program on resident skills in communicating with families in an ICU and on family outcomes. METHODS We conducted a prospective, single-site educational intervention study. The intervention featured a weekly required communication training program (4 h total) during the ICU rotation, which included interactive discussion, and role play with immediate feedback from simulated family members. All internal medicine residents on ICU rotation between July 2012 and July 2014 were invited to participate in the study. Family members who had a meeting with an enrolled resident were approached for a survey or interview. The primary outcome was family ratings of how well residents met their informational and emotional needs. MEASUREMENTS AND MAIN RESULTS The response rate for the resident baseline survey was 93% (n = 149 of 160), and it was 90% at postcourse and 84% at 3-month follow-up. Of 303 family members approached, 237 were enrolled. Enrolled family members who had a confirmed meeting with a resident were eligible to complete a survey or interview. The completion rate was 86% (n = 82 of 95). Family members were more likely to describe residents as having "fully met" (average rating of 10/10 on 0-10 scale) their informational and emotional needs when the resident had completed two or three course sessions (84% of family members said conversation with these residents "fully met" their needs), as compared with residents who had taken one session or no sessions (25% of family members said needs were "fully met") (P < 0.0001). Residents described improvements across all domains. All differences are statistically significant, most with large effect sizes. CONCLUSIONS At our institution, an on-site communication training program designed for integration into medical residency programs was associated with strongly positive family member outcomes and significant improvements in residents' perceived skills. This intervention may serve to prepare residents for optimal communications with patients and family members in ICUs and elsewhere.
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22
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Chappell PM, Healy J, Lee S, Medellin G, Sanchez-Reilly S. Communicating With Dying Patients and Their Families: Multimedia Training in End-of-Life Care. Am J Hosp Palliat Care 2016; 34:637-644. [DOI: 10.1177/1049909116655293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The need for end-of-life (EOL), high-impact education initiatives to prepare medical students to communicate with dying patients and their families and to cope with issues of death and dying, is well recognized. Methods: Third-year medical students (n = 224), during their ambulatory rotation, completed a multimedia EOL curriculum, which included pre-/posttests, an online case-based module, didactic presentation, and a tablet computer application designed to demonstrate the signs and symptoms seen in the last hours of life for families of dying patients. Pre- and posttests were compared using Pearson χ2 or Fisher exact test, and improvement was measured by weighted κ coefficient. Results: On preintervention surveys, the majority of students demonstrated positive attitudes toward the care of dying patients and their families. Despite this high pretest positive attitude, there was a statistically significant overall positive attitude change after the intervention. The lowest pretest positive attitudes and lowest posttest positive attitude shifts, although all statistically improved, involved addressing the thoughts and feelings of dying patients and in coping with their own emotional response. Conclusions: Medical students exposure to this multimedia EOL curriculum increases positive attitudes in caring for dying patients and their families.
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Affiliation(s)
- Phylliss M. Chappell
- Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jennifer Healy
- GRECC/GECC, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Shuko Lee
- GRECC/GECC, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Glen Medellin
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health System, San Antonio, TX, USA
| | - Sandra Sanchez-Reilly
- GRECC/GECC, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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23
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DeVita MA. Simulation and the Prognosis for the Apprenticeship Model of Health Care Education. J Intensive Care Med 2016; 22:310-1. [PMID: 17895489 DOI: 10.1177/0885066607304435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chung HO, Oczkowski SJW, Hanvey L, Mbuagbaw L, You JJ. Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2016; 16:131. [PMID: 27129790 PMCID: PMC4850701 DOI: 10.1186/s12909-016-0653-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/26/2016] [Indexed: 05/15/2023]
Abstract
BACKGROUND Practicing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families. We conducted a systematic review to evaluate the effectiveness of educational interventions aimed at providing healthcare professionals with training in end-of-life communication skills, compared to usual curriculum. METHODS We searched MEDLINE, Embase, CINAHL, ERIC and the Cochrane Central Register of Controlled Trials from the date of inception to July 2014 for randomized control trials (RCT) and prospective observational studies of educational training interventions to train healthcare professionals in end-of-life communication skills. To be eligible, interventions had to provide communication skills training related to end-of-life decision making; other interventions (e.g. breaking bad news, providing palliation) were excluded. Our primary outcomes were self-efficacy, knowledge and end-of-life communication scores with standardized patient encounters. Sufficiently similar studies were pooled in a meta-analysis. The quality of evidence was assessed using GRADE. RESULTS Of 5727 candidate articles, 20 studies (6 RCTs, 14 Observational) were included in this review. Compared to usual teaching, educational interventions to train healthcare professionals in end-of-life communication skills were associated with greater self-efficacy (8 studies, standardized mean difference [SMD] 0.57;95% confidence interval [CI] 0.40-0.75; P < 0.001; very low quality evidence), more knowledge (4 studies, SMD 0.76;95% CI 0.40-1.12; p < 0.001; low quality evidence), and improvements in communication scores (8 studies, SMD 0.69; 95% CI 0.41-0.96; p < 0.001; very low quality evidence). There was insufficient evidence to determine whether these educational interventions affect patient-level outcomes. CONCLUSION Very low to low quality evidence suggests that end-of-life communication training may improve healthcare professionals' self-efficacy, knowledge, and EoL communication scores compared to usual teaching. Further studies comparing two active educational interventions are recommended with a continued focus on contextually relevant high-level outcomes. TRIAL REGISTRATION PROSPERO CRD42014012913.
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Affiliation(s)
- Han-Oh Chung
- , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada.
| | - Simon J W Oczkowski
- Hamilton General Hospital, McMaster Clinic 4th floor, Room 434, 237 Barton St East, Hamilton, Ontario, L8L2X2, Canada
| | - Louise Hanvey
- Canadian Hospice Palliative Care Association, Annex D, Saint-Vincent Hospital, 60 Cambridge Street North, Ottawa, ON, K1R 7A5, Canada
| | - Lawrence Mbuagbaw
- , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada
- St Joseph's Healthcare, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, Ontario, L8N4A6, Canada
| | - John J You
- , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada
- St Joseph's Healthcare, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, Ontario, L8N4A6, Canada
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Carnevale FA, Farrell C, Cremer R, Séguret S, Canouï P, Leclerc F, Lacroix J, Hubert P. Communication in pediatric critical care: A proposal for an evidence-informed framework. J Child Health Care 2016; 20:27-36. [PMID: 25038056 DOI: 10.1177/1367493514540817] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this investigation was to conduct a comprehensive examination of communication between parents and health care professionals (HCPs) in the pediatric intensive care unit (PICU). A secondary analysis was performed on data from 3 previous qualitative studies, which included 30 physicians, 37 nurses, and 38 parents in France and Quebec (Canada). All three studies examined a mix of cases where children either survived or died. All data referring to communication between parents (and patients when applicable) and HCPs were examined to identity themes that related to communication. Thematic categories for parents and HCPs were developed. Three interrelated dimensions of communication were identified: (1) informational communication, (2) relational communication, and (3) communication and parental coping. Specific themes were identified for each of these 3 dimensions in relation to parental concerns as well as HCP concerns. This investigation builds on prior research by advancing a comprehensive analysis of PICU communication that includes (a) cases where life-sustaining treatments were withdrawn or withheld as well as cases where they were maintained, (b) data from HCPs as well as parents, and (c) investigations conducted in 4 different sites. An evidence-informed conceptual framework is proposed for PICU communication between parents and HCPs. We also outline priorities for the development of practice, education, and research.
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Karabilgin OS, Altug N, Caliskan SA, Bozoklar CA, Durak HI, Demiral-Yilmaz N. Withdrawn: Simulated Donor Family Encounters at Organ Transplantation Coordinators In-service Training Course: Process and Impact Evaluation. Transplant Proc 2015; 47:1572-9. [PMID: 26293015 DOI: 10.1016/j.transproceed.2015.03.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/04/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The study was aimed at introducing the modified version of the organ transplantation coordinator course including simulated donor family encounters (SDFEs), communication skills, and evaluating the participants' opinions, achievement levels, and how they implemented what they learned in the course in their work settings. METHODS The course was modified using the ADDIE (analysis, design, development, implementation, and evaluation) model and was evaluated in three steps: The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the post-test and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through phone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. RESULTS The participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly use their communication and empathy skills during donor family encounters. The participants' mean post-test score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. CONCLUSION It can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters.
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Affiliation(s)
- O S Karabilgin
- Ege University Faculty of Medicine, Department of Medical Education, Izmir, Turkey
| | - N Altug
- Ege University Faculty of Medicine, Organ Transplantation Application and Research Center, Izmir, Turkey
| | - S A Caliskan
- Ege University Faculty of Medicine, Department of Medical Education, Izmir, Turkey
| | - C A Bozoklar
- Istanbul Bilim University Faculty of Medicine, General Surgery, Istanbul, Turkey
| | - H I Durak
- Ege University Faculty of Medicine, Department of Medical Education, Izmir, Turkey
| | - N Demiral-Yilmaz
- Ege University Faculty of Medicine, Department of Medical Education, Izmir, Turkey.
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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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Simulated Donor Family Encounters at Organ Transplantation Coordinators In-Service Training Course: Process and Impact Evaluation. Transplant Proc 2015; 47:1249-56. [PMID: 26093692 DOI: 10.1016/j.transproceed.2015.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study introduced the modified version of the Organ Transplantation Coordinator course including simulated donor family encounters (SDFEs) and communication skills. It also evaluated participants' opinions and achievement levels, and how they implemented what they learned in the course in their work settings. METHODS The course used the modified Analysis, Design, Development, Implementation, and Evaluation model and was evaluated in 3 steps. The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the posttest and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through telephone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. RESULTS The participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly utilize their communication and empathy skills during donor family encounters. The participants' mean posttest score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. CONCLUSIONS It can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters.
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Hsu LL, Chang WH, Hsieh SI. The Effects of Scenario-Based Simulation Course Training on Nurses' Communication Competence and Self-Efficacy: A Randomized Controlled Trial. J Prof Nurs 2015; 31:37-49. [DOI: 10.1016/j.profnurs.2014.05.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Indexed: 11/29/2022]
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The Critical Care Communication project: improving fellows' communication skills. J Crit Care 2014; 30:250-4. [PMID: 25535029 DOI: 10.1016/j.jcrc.2014.11.016] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 11/25/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to develop an evidence-based communication skills training workshop to improve the communication skills of critical care fellows. MATERIALS AND METHODS Pulmonary and critical care fellows (N = 38) participated in a 3-day communication skills workshop between 2008 and 2010 involving brief didactic talks, faculty demonstration of skills, and faculty-supervised small group skills practice sessions with simulated families. Skills included the following: giving bad news, achieving consensus on goals of therapy, and discussing the limitations of life-sustaining treatment. Participants rated their skill levels in a pre-post survey in 11 core communication tasks using a 5-point Likert scale. RESULTS Of 38 fellows, 36 (95%) completed all 3 days of the workshop. We compared pre and post scores using the Wilcoxon signed rank test. Overall, self-rated skills increased for all 11 tasks. In analyses by participant, 95% reported improvement in at least 1 skill; with improvement in a median of 10 of 11 skills. Ninety-two percent rated the course as either very good/excellent, and 80% recommended that it be mandatory for future fellows. CONCLUSIONS This 3-day communication skills training program increased critical care fellows' self-reported family meeting communication skills.
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Grant MS, Jenkins LS. Communication education for pre-licensure nursing students: literature review 2002-2013. NURSE EDUCATION TODAY 2014; 34:1375-1381. [PMID: 25151020 DOI: 10.1016/j.nedt.2014.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/06/2014] [Accepted: 07/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Effective communication skills are fundamental to good nursing care and required by certification bodies for nursing education. The purpose of this literature review was to update one done in 2002 of communication education to pre-licensure registered nursing students. That review concluded that it was unclear which interventions were most effective due to methodological and other quality issues. The goal of this review was to identify recent educational methods, frameworks, and evaluation tools and to assess the quality of this recent evidence. DESIGN Literature review. DATA SOURCES PubMed, CINAHL, and PsychINFO. REVIEW METHODS Inclusion criteria were articles in English, 2002 to 2013, full text available, addressing nurse:patient communication, and educational interventions. Exclusion criteria were inter-professional interventions as they are not yet as widely available. Studies were evaluated using the Johns Hopkins Nursing Evidence-based Practice (JHNEBP) Rating Scale. This scale categorizes the levels of evidence and methodological quality. RESULTS The search yielded 457 titles, 115 abstracts, and 38 articles. Twenty studies met inclusion and exclusion search criteria. They included a range of research designs, samples, and outcomes. In line with recent communication educational trends, the interventions all involved active learning. Using the JHNEBP scale, the quality of the 20 studies was low due to both research design and methodological issues. CONCLUSION Despite the importance of communication in nursing education, the quality of evidence to support specific communication interventions continues to be low. Recommendations for future communication education research are to (1) explore the highest quality designs available and use randomization where possible; (2) more consistently use theoretical frameworks and their accompanying outcome measures; and (3) that tools be tested for evidence of reliability and validity.
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Affiliation(s)
- Marian S Grant
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, United States.
| | - Louise S Jenkins
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, United States
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Blackhall LJ, Erickson J, Brashers V, Owen J, Thomas S. Development and Validation of a Collaborative Behaviors Objective Assessment Tool for End-of-Life Communication. J Palliat Med 2014; 17:68-74. [DOI: 10.1089/jpm.2013.0262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - John Owen
- University of Virginia School of Medicine, Charlottesville, Virginia
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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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Kyeremanteng K. How palliative care can reduce healthcare costs & improve quality of care. Health (London) 2013. [DOI: 10.4236/health.2013.512283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Using standardized family members to teach communication skills and ethical principles to critical care trainees. Crit Care Med 2012; 40:1814-9. [PMID: 22610186 DOI: 10.1097/ccm.0b013e31824e0fb7] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to determine the effectiveness of standardized family members for improving communication skills and ethical and legal knowledge of senior intensive care unit trainees. DESIGN Multimodal evaluation of mixed-methods educational intervention. SETTING Postgraduate critical care medicine academic program. SUBJECTS Postgraduate subspecialty critical care medicine trainees. INTERVENTION Communication workshop featuring a short didactic session and four simulated family meetings using trained professionals as standardized family members. MEASUREMENTS Ethical and legal knowledge and comfort with communication (before and after the workshop) and communication skill (during the workshop). MAIN RESULTS Fifty-one postgraduate critical care medicine subspecialty trainees participated in the workshop over a 5-yr period. Ethical and legal knowledge and comfort scores improved significantly among trainees who participated in the workshop. Ninety percent of trainees felt that the workshop had met or exceeded their expectations and would recommend it to other trainees. Ninety-eight percent of trainees felt that the workshop had met the highest priority learning objectives they identified. Communication scores showed a trend towards improvement over the course of the workshop, although the improvements were not significant. Participants reflecting on the workshop >1 yr later overwhelmingly felt that it had prepared them for real communication challenges in training and practice. CONCLUSIONS This workshop was effective for improving ethical and legal knowledge and comfort with communication among critical care medicine trainees. Participants overwhelmingly felt that it had met their learning needs and that it was an effective teaching tool that had prepared them for real communication challenges in training and practice. It could be used in a variety of contexts to address an often-neglected area of education.
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Using standardized family members to teach end-of-life skills to critical care trainees. Crit Care Med 2012; 40:1978-80. [PMID: 22610211 DOI: 10.1097/ccm.0b013e3182536cd1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Standardized patient-narrated web-based learning modules improve students' communication skills on a high-stakes clinical skills examination. J Gen Intern Med 2011; 26:1374-7. [PMID: 21769506 PMCID: PMC3208474 DOI: 10.1007/s11606-011-1809-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/04/2011] [Accepted: 07/06/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Use of web-based standardized patient (SP) modules is associated with improved medical student history-taking and physical examination skills on clinical performance examinations (CPX), but a benefit for communication skills has not been shown. AIM We describe an innovative web-based SP module using detailed SP and faculty commentary to teach communication skills. SETTING A public medical school in 2008-2009. PARTICIPANTS Fourth-year medical students. PROGRAM DESCRIPTION A 90-minute web-based module with three simulated clinical encounters was narrated by an expert clinician and SP to explain expected history-taking, physical examination, and communication skills behaviors. All 147 students were encouraged to review the module one month before the CPX. PROGRAM EVALUATION One hundred and six students (72%) viewed the web-based module. Students who watched the module performed significantly higher on the CPX communication score (+2.67%, p < 0.01) and overall score (+2.12%, p = 0.03), even after controlling for USMLE Step 1 and clerkship summary ratings. Use of the module did not significantly affect history/physical examination scores (+1.89%, p = 0.12). DISCUSSION Students who watched an optional web-based SP module prior to the CPX performed higher than those who did not on communication skills. The web-based module appears to be an effective CPX preparatory activity to enhance communication performance.
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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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Downar J, Luk T, Sibbald RW, Santini T, Mikhael J, Berman H, Hawryluck L. Why do patients agree to a "Do not resuscitate" or "Full code" order? Perspectives of medical inpatients. J Gen Intern Med 2011; 26:582-7. [PMID: 21222172 PMCID: PMC3101966 DOI: 10.1007/s11606-010-1616-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 11/01/2010] [Accepted: 12/07/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND The majority of patients who die in hospital have a "Do Not Resuscitate" (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don't, and how they view discussions of resuscitation status. METHODS We conducted semi-structured interviews of English-speaking medical inpatients who had clearly requested a DNR or full code (FC) order after a discussion with their admitting team, and analyzed the transcripts using a modified grounded-theory approach. RESULTS We achieved conceptual saturation after conducting 44 interviews (27 DNR, 17 FC) over a 4-month period. Patients in the DNR group were much older than those in the FC group, but they had broadly similar admission diagnoses and comorbidities. DNR patients reported much greater familiarity with the subject and described a more positive experience than FC patients with their resuscitation discussions. Participants typically requested FC or DNR orders based on personal, relational or philosophical considerations, but these considerations manifested differently depending on the participant's preference for resuscitation. Most FC patients stated that would not want a prolonged period of life support, and they would not want resuscitation in the event of a poor quality of life. FC and DNR patients understood resuscitation and DNR orders differently. DNR patients described resuscitation in graphic, concrete terms that emphasized suffering and futility, and DNR orders in terms of comfort or natural processes. FC patients understood resuscitation in an abstract sense as something that restores life, while DNR orders were associated with substandard care or even euthanasia. CONCLUSION Our study identified important differences and commonalities between the perspectives of DNR and FC patients. We hope that this information can be used to help physicians better understand the needs of their patients when discussing resuscitation.
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Affiliation(s)
- James Downar
- Department of Medicine, University of Toronto, 200 Elizabeth St. 9N-926, Toronto M5G 2C4, Canada.
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Kelly D. The Knowledge of Medical Students and Newly Qualified Doctors concerning the Specialty of Intensive Care Medicine. J Intensive Care Soc 2011. [DOI: 10.1177/175114371101200205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Current evidence suggests that around the transition from undergraduate to postgraduate training, deficiencies exist in doctors' knowledge of acute care. This study assessed Foundation Year 1 (FY1) doctors and medical students in intensive care/acute medicine with respect to their understanding of ICU practice and identifying critically ill patients. A qualitative questionnaire was formulated focusing on several targeted areas including training experience, broader ICU knowledge, formal assessment of ICU medicine and critically ill patients encountered outside the ICU. After successfully piloting the study, ethics approval was granted. In February 2010, the questionnaires were distributed to 50 final-year medical students at Brighton and Sussex Medical School and 50 FY1 doctors working at Worthing Hospital or the Royal Sussex County Hospital. One hundred percent of participants completed the questionnaires; 12.5% of medical students knew about the Surviving Sepsis Campaign compared to 62% FY1s (p<0.05). Non-significant trends were evident when choosing three most useful observations for identifying sick patients. The study concluded medical students lack knowledge regarding assessment and monitoring of critically ill patients. Undergraduate training and ICU exposure did not differ between groups, however differences existed in understanding of ICU practice. There was a relative paucity in understanding from final year students regarding the Surviving Sepsis Campaign compared to FY1 doctors, which highlights the need for further improvement.
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Green MJ, Levi BH. Teaching advance care planning to medical students with a computer-based decision aid. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:82-91. [PMID: 20632222 PMCID: PMC3737727 DOI: 10.1007/s13187-010-0146-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Discussing end-of-life decisions with cancer patients is a crucial skill for physicians. This article reports findings from a pilot study evaluating the effectiveness of a computer-based decision aid for teaching medical students about advance care planning. Second-year medical students at a single medical school were randomized to use a standard advance directive or a computer-based decision aid to help patients with advance care planning. Students' knowledge, skills, and satisfaction were measured by self-report; their performance was rated by patients. 121/133 (91%) of students participated. The Decision-Aid Group (n = 60) outperformed the Standard Group (n = 61) in terms of students' knowledge (p < 0.01), confidence in helping patients with advance care planning (p < 0.01), knowledge of what matters to patients (p = 0.05), and satisfaction with their learning experience (p < 0.01). Likewise, patients in the Decision Aid Group were more satisfied with the advance care planning method (p < 0.01) and with several aspects of student performance. Use of a computer-based decision aid may be an effective way to teach medical students how to discuss advance care planning with cancer patients.
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Affiliation(s)
- Michael J Green
- Departments of Humanities and Internal Medicine, Penn State College of Medicine, C1743, 500 University Drive, Hershey, PA 17033, USA.
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Lamiani G, Meyer EC, Leone D, Vegni E, Browning DM, Rider EA, Truog RD, Moja EA. Cross-cultural adaptation of an innovative approach to learning about difficult conversations in healthcare. MEDICAL TEACHER 2011; 33:e57-e64. [PMID: 21275534 DOI: 10.3109/0142159x.2011.534207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The Program to Enhance Relational and Communication Skills (PERCS) was developed at a large hospital in the United States to enhance clinicians' preparedness to engage in difficult conversations. AIM To describe the implementation of PERCS in an Italian hospital and assess the program's efficacy. METHODS The Italian PERCS program featured 4-h experiential workshops enrolling 10-15 interdisciplinary participants. The workshops were organized around the enactment and debriefing of realistic case scenarios portrayed by actors and volunteer clinicians. Before and after the workshop, participants rated their perceived preparation, communication and relational skills, confidence, and anxiety on 5-point Likert scales. Open-ended questions explored their reflections on the learning. T-tests and content analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS 146 clinicians attended 13 workshops. Participants reported better preparation, confidence, and communication skills (p < 0.001) after the workshops. The program had a different impact depending on the discipline. Participants valued the emphasis on group feedback, experiential and interdisciplinary learning, and the patient's perspective, and acquired: new communication skills, self-reflective attitude, reframed perspective, and interdisciplinary teamwork. CONCLUSION PERCS proved culturally adaptable to the Italian context and effective in improving participants' sense of preparation, communication skills, and confidence.
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Ratnapalan M, Cooper AB, Scales DC, Pinto R. Documentation of best interest by intensivists: a retrospective study in an Ontario critical care unit. BMC Med Ethics 2010; 11:1. [PMID: 20146820 PMCID: PMC2835711 DOI: 10.1186/1472-6939-11-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 02/10/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive care physicians often must rely on substitute decision makers to address all dimensions of the construct of "best interest" for incapable, critically ill patients. This task involves identifying prior wishes and to facilitate the substitute decision maker's understanding of the incapable patient's condition and their likely response to treatment. We sought to determine how well such discussions are documented in a typical intensive care unit. METHODS Using a quality of communication instrument developed from a literature search and expert opinion, 2 investigators transcribed and analyzed 260 handwritten communications for 105 critically ill patients who died in the intensive care unit between January and June 2006. Cohen's kappa was calculated before analysis and then disagreements were resolved by consensus. We report results on a per-patient basis to represent documented communication as a process leading up to the time of death in the ICU. We report frequencies and percentages for discrete data, median (m) and interquartile range (IQR) for continuous data. RESULTS Our cohort was elderly (m 72, IQR 58-81 years) and had high APACHE II scores predictive of a high probability of death (m 28, IQR 23-36). Length of stay in the intensive care unit prior to death was short (m 2, IQR 1-5 days), and withdrawal of life support preceded death for more than half (n 57, 54%). Brain death criteria were present for 18 patients (17%). Although intensivists' communications were timely (median 17 h from admission to critical care), the person consenting on behalf of the incapable patient was explicitly documented for only 10% of patients. Life support strategies at the time of communication were noted in 45% of charts, and options for their future use were presented in 88%. Considerations relevant to determining the patient's best interest in relation to the treatment plan were not well documented. While explicit survival estimates were noted in 50% of charts, physicians infrequently documented their own predictions of the patient's functional status (20%), anticipated need for chronic care (0%), or post ICU quality of life (3%). Similarly, documentation of the patient's own perspectives on these ranged from 2-18%. CONCLUSIONS Intensivists' documentation of their communication with substitute decision makers frequently outlined the proposed plan of treatment, but often lacked evidence of discussion relevant to whether the treatment plan was expected to improve the patient's condition. Legislative standards for determination of best interest, such as the Health Care Consent Act in Ontario, Canada, may provide guidance for intensivists to optimally document the rationales for proposed treatment plans.
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Affiliation(s)
- Mohana Ratnapalan
- Department of Critical Care Medicine, William Osler Health System, Brampton Civic Hospital, 2100 Bovaird Drive East, Brampton, Ontario L6R3J7, Canada
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Zavertnik JE, Huff TA, Munro CL. Innovative Approach to Teaching Communication Skills to Nursing Students. J Nurs Educ 2010; 49:65-71. [DOI: 10.3928/01484834-20090918-06] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 11/03/2008] [Indexed: 11/20/2022]
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Haidet P, Fecile ML, West HF, Teal CR. Reconsidering the team concept: educational implications for patient-centered cancer care. PATIENT EDUCATION AND COUNSELING 2009; 77:450-455. [PMID: 19850437 PMCID: PMC2787698 DOI: 10.1016/j.pec.2009.09.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 07/15/2009] [Accepted: 09/11/2009] [Indexed: 05/28/2023]
Abstract
Patient-centered cancer care has become a priority in the oncology field. Increasing efforts to train oncologists in communication skills have led to a growing literature on patient-centered cancer education. In addition, systems approaches have led to an increased emphasis on the concept of teams as an organizing framework for cancer care. In this essay, we examine issues involved in educating teams to provide patient-centered cancer care. In the process, we question the applicability of a tightly coordinated 'team' concept, and suggest the concept of a 'care community' as a more achievable ideal for the way that cancer care is commonly delivered. We discuss the implications that this has for cancer communication education, and propose three principles to guide the development of educational interventions aimed at increasing patient-centeredness in cancer care delivery systems.
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Affiliation(s)
- Paul Haidet
- Office of Medical Education and the Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive (HU15), Hershey, PA 17033, USA.
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[A national survey of medical students about the specialty of Intensive Medicine and intensive care units]. Med Intensiva 2009; 33:363-9. [PMID: 19912967 DOI: 10.1016/j.medin.2009.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 05/18/2009] [Accepted: 05/19/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the degree of knowledge about intensive medicine and interest in this specialty among medical students in Spain. DESIGN A survey with closed questions. SETTING Complutense University of Madrid, Autonomous University of Madrid, University of Salamanca, Autonomous University of Barcelona, University of Granada, and University of Alcalá de Henares. PARTICIPANTS Medical students from the above-mentioned universities. RESULTS A total of 377 medical students (mean age: 21.3+/-1.9 years) were included. Women made up 75.3% of the sample; 37.7% of the students surveyed were in their third year (of six total), and the rest were distributed equally among the other five years with the exception of the first year (1.6%). Most students (85.1%) stated that they studied medicine because they had a vocation for the profession, whereas 7.7% stated that they studied medicine because of the influence of their families. A total of 45.7% said they were making good grades and 16.7% needed to repeat some subjects. Students' knowledge of ICUs came from different sources: television (35%), personal experience (25.2%), and friends and/or family (35%); 16.4% had no knowledge of the ICU. ICUs were associated with intensivists in 86.5%. Most students said that ICUs treat patients with multiple trauma (85.4%), postoperative patients (68.4%), coronary patients (62.3%), respiratory patients (61.5%), and neurological patients (50.7%). The techniques that students considered were frequently employed in ICUs included mechanical ventilation (89.4%), orotracheal intubation (83.8%), intravenous sedation (71.1%), central venous lines (70.8%), intravenous analgesia (69.8%), nasogastric catheterization (63.9%), antibiotics (62.3%), total parenteral nutrition (56%), and tracheostomy (53.5%); less frequently mentioned were peripheral venous line placement (52.5%), temporary pacemaker placement (40.1%), arterial line placement (40.6%), Swan-Ganz catheterization (38.6%), intramuscular relaxation (32.4%), thoracocentesis (31,3%), continuous hemofiltration (28.9%), lumbar puncture (28.6%), and permanent pacemaker placement (19.7%). Students believe that intensivists participate in maintaining organ donors (70.6%) but little in detecting organ donors (40%) or in asking families for permission to extract organs (40.1%). Finally, 52% said that they will consider intensive medicine when specializing. CONCLUSION Although some aspects of intensive medicine are not well known among medical students, the general level of knowledge about intensive medicine is acceptable and more than half of the medical students surveyed will consider it when deciding on a specialty.
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Lyss-Lerman P, Teherani A, Aagaard E, Loeser H, Cooke M, Harper GM. What training is needed in the fourth year of medical school? Views of residency program directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:823-9. [PMID: 19550170 DOI: 10.1097/acm.0b013e3181a82426] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE To identify common struggles of interns, determine residency program directors' (PDs') views of the competencies to be gained in the fourth year of medical school, and apply this information to formulate goals of curricular reform and student advising. METHOD In 2007, semistructured interviews were conducted with 30 PDs in the 10 most common specialty choices of students at the University of California, San Francisco, School of Medicine to assess the PDs' priorities for knowledge, skills, and attitudes to be acquired in the fourth year. Interviews were coded to identify major themes. RESULTS Common struggles of interns were lack of self-reflection and improvement, poor organizational skills, underdeveloped professionalism, and lack of medical knowledge. The Accreditation Council for Graduate Medical Education competencies of patient care, practice-based learning and improvement, interpersonal and communication skills, and professionalism were deemed fundamental to fourth-year students' development. Rotations recommended across specialties were a subinternship in a student's future field and in internal medicine (IM), rotations in an IM subspecialty, critical care, and emergency and ambulatory medicine. PDs encouraged minimizing additional time spent in the student's future field. Suggested coursework included an intensively coached transitional subinternship and courses to improve students' medical knowledge. CONCLUSIONS PDs deemed the fourth year to have a critical role in the curriculum. There was consensus about expected fourth-year competencies and the common clinical experiences that best prepare students for residency training. These findings support using the fourth year to transition students to graduate medical training and highlight areas for curricular innovation.
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