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Posey L, Wallington S, Sikka N, Pericak A, Zhou Q, Pintz C. Evaluating a Virtual Flipped Classroom Approach to Nurse Practitioner Telehealth Competency Development. J Nurs Educ 2024; 63:546-551. [PMID: 39120504 DOI: 10.3928/01484834-20240502-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
BACKGROUND Evidence supports the use of multi-modal approaches to develop nurse practitioner (NP) students' telehealth competency. METHOD A virtual flipped classroom approach that included eLearning, interactive webinars, and virtual standardized patient (SP) simulations was implemented and evaluated to teach NP students to use telehealth and other connected health technologies to improve care for underserved populations. RESULTS Analysis of data from multiple-choice quizzes, surveys, and SP evaluations indicated students achieved high levels of knowledge, met the learning objectives, demonstrated above-average competency during telehealth simulations that improved over time, and were highly satisfied with the learning experiences. CONCLUSION The educational benefits of a flipped classroom can be realized within a fully online learning experience. Future research should examine the effects of repeated simulation opportunities on telehealth competency development. [J Nurs Educ. 2024;63(8):546-551.].
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Choi A, Murtha TD, Morrison LJ, Talwalkar JS. A Comparison Between In-Person and Virtual Communication Skills OSCE for Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241241375. [PMID: 38532857 PMCID: PMC10964456 DOI: 10.1177/23821205241241375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
Objectives This study investigates the effectiveness of a virtual format of an advanced communication skills observed structured clinical examination (OSCE) for senior medical students in comparison to an in-person format. The study also examines the emotional support students experience in the virtual setting. Our analysis was based on quantitative data collected through objective checklists and post-OSCE survey results. Methods The virtual OSCE was a revision of an earlier in-person formative advanced communication skills OSCE for fourth-year medical students. Student performances were assessed by self and peers using objective checklists-the modified Master Interview Rating Scale (mMIRS) and Communication Behavior Checklist (CBC). The mMIRS measured interview process such as avoiding jargon and demonstrating empathy. The CBC examined interview content which included tasks specific to the content of the case. The OSCE was followed by a faculty-led debrief and quantitative survey. The virtual OSCE was conducted in 2021, and the results of the checklists and survey were compared with those collected from two earlier in-person OSCEs. Results Eighty-three students participated in the virtual OSCE. There was no difference in mMIRS scores between the virtual and in-person OSCE. Overall CBC scores were lower in the virtual OSCE compared to in-person (p < 0.05). Sixty-seven out of 83 (80.7%) students completed the post-OSCE survey. There were no differences between the virtual and in-person OSCE in terms of educational value, whether the OSCE would change the way participants talk to patients, and preparedness to have serious conversations with patients. All respondents somewhat or strongly agreed with feeling emotionally supported during the virtual OSCE. Conclusion The virtual format was a suitable alternative to an in-person, formative, advanced communication skills OSCE for medical students. The virtual OSCE was educationally effective and was met with student satisfaction and a sense of emotional support. Future virtual iterations must ensure adequate instruction on interview content.
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Affiliation(s)
- Alex Choi
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tanya D. Murtha
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Jaideep S. Talwalkar
- Departments of Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Hoffert MM, Newman J, Mortimore A, Passalacqua KD, Abreu Lanfranco O. Explicit Training in Systematic Communication Strategies: A Pilot Study Exploring the Incorporation of Communication Tools by First-Year Residents in Simulation and in Clinical Practice. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241256042. [PMID: 38765320 PMCID: PMC11102694 DOI: 10.1177/23821205241256042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Educational approaches for training physicians in clinical communications vary, and whether physicians apply the communication skills they learn or find them useful in the clinic is not well known. The aim of this study was to determine how first-year residents who received explicit instruction in 7 communication strategies would apply them in a simulation exercise and in clinical practice. METHODS First-year Internal Medicine residents at an urban teaching hospital received instruction in 7 systematic communication strategies: Ask-Tell-Ask, Teach-back, open-ended questioning, NURSE, open body language, pausing, and plain language. Residents were evaluated on their use of specific communication behaviors associated with the 7 strategies during a simulation exercise of disclosing a medical error to a standardized patient. Control group residents who did the simulation before attending the training program and training group residents who did the simulation after the training were compared. Residents were queried 6 months after the training program on their use of communication strategies during clinical practice. RESULTS A total of 27 residents participated (n = 13 control group; n = 14 training group). The training group performed behaviors for "establishing patient understanding" significantly more often than the control group. Both groups used non-verbal communication and behaviors for addressing patient emotions at similar levels. Of the 24 residents who responded to the 6-month follow-up questionnaire, 24 (100%) reported using Ask-Tell-Ask, open-ended questioning, and Teach-back, and 22 (92%) reported using NURSE statements and non-verbal communication. Most respondents reported using the strategies in clinical practice often or very often (79%) and found the strategies useful or very useful (96%). CONCLUSION Providing explicit instruction in systematic communication strategies, particularly those focused on establishing patient understanding, may be an efficient approach for helping early career physicians develop effective communication skills that can be readily implemented during clinical training and practice.
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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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Nalda CM, McSherry ML, Schmidt CM, Neumann ML, Boss RD, Weaver MS. Video tools in pediatric goals of care communication: A systematic review. PEC INNOVATION 2022; 1:100029. [PMID: 37213739 PMCID: PMC10194233 DOI: 10.1016/j.pecinn.2022.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 05/23/2023]
Abstract
•Goals of Care resources are primarily in written format and for adult patients.•Video tools can support families of pediatric patients facing prognostic uncertainty.•Videos represent an effective but underutilized Goals of Care communication tool.
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Affiliation(s)
- Caitlin M. Nalda
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD, USA
- Corresponding author at: 200 N Wolfe Street, Room 2019, Baltimore, MD 21287, USA.
| | - Megan L. McSherry
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Cynthia M. Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marie L. Neumann
- Division of Transplant Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Communication Studies, University of Nebraska- Lincoln, Lincoln, NE, USA
| | - Renee D. Boss
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neonatal - Perinatal Medicine, Berman Institute of Bioethics, Baltimore, MD, USA
| | - Meaghann S. Weaver
- National Center for Ethics in Health Care, Washington, DC, USA
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
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Isaksson J, Krabbe J, Ramklint M. Medical students' experiences of working with simulated patients in challenging communication training. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:32. [PMID: 36217210 PMCID: PMC9552443 DOI: 10.1186/s41077-022-00230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physicians' communication skills are important for patient-centered care. Although working with simulated patients (SPs) in case simulations is common for training communication skills, studies seldom include a wide range of challenging behaviors or explore students' own experiences of learning communication skills with SPs. Therefore, this study was aimed at investigating how medical students perceive communication training involving challenging consultations with SPs and the impact on their learning experiences. METHODS Twenty-three medical students from the same class were interviewed in focus groups about their experiences of simulation training with actors as SPs. In the simulation training, the students were instructed to deliver bad news, manage negative patient reactions, and encourage behavioral changes in reluctant patients. This was followed by feedback and a debriefing exercise. The interviews were analyzed with content analysis. RESULTS Students reported that actors as SPs made the simulations more realistic and enabled them to practice various communication skills for challenging consultations in a safe way and manage their own feelings, thereby promoting new learning experiences. Elements such as actors' flexibility in changing behaviors during role-play and exposure to different challenging behaviors, like negative emotions, were regarded as valuable. The importance of an accepting and permissive climate for the debriefing exercise was highlighted, though without taking too much time from the simulation training. Feedback directly from the SP was appreciated. CONCLUSIONS Actors as SPs were perceived as a valuable part of challenging communication training and added elements to the learning process. Future studies should include a wider range of challenging behaviors in training with SPs and evaluate the effects of such training on students' use of communication skills.
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Affiliation(s)
- Johan Isaksson
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. .,Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
| | - Julia Krabbe
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Poluch M, Feingold-Link J, Ankam N, Kilpatrick J, Cameron K, Chandra S, Doty A, Klein M, McCarthy D, Rising K, Salzman D, Ziring D, Papanagnou D. I Don't Have a Diagnosis for You: Preparing Medical Students to Communicate Diagnostic Uncertainty in the Emergency Department. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11218. [PMID: 35178469 PMCID: PMC8814030 DOI: 10.15766/mep_2374-8265.11218] [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: 07/27/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Diagnostic uncertainty abounds in medicine, and communication of that uncertainty is critical to the delivery of high-quality patient care. While there has been training in communicating diagnostic uncertainty directed towards residents, a gap remains in preparing medical students to understand and communicate diagnostic uncertainty. We developed a session to introduce medical students to diagnostic uncertainty and to practice communicating uncertainty using a checklist during role-play patient conversations. METHODS This virtual session was conducted for third-year medical students at the conclusion of their core clerkships. It consisted of prework, didactic lecture, peer role-play, and debriefing. The prework included reflection prompts and an interactive online module. The role-play featured a patient complaining of abdominal pain being discharged from the emergency department without a confirmed diagnosis. Students participated in the role of patient, provider, or observer. RESULTS Data from an anonymous postsession survey (76% response rate; 202 of 265 students) indicated that most students (82%; 152 of 185) felt more comfortable communicating diagnostic uncertainty after the session. A majority (83%; 166 of 201) indicated the session was useful, and most (81%; 149 of 184) indicated it should be included in the curriculum. DISCUSSION This virtual session requires few facilitators; has peer role-play, eliminating the need for standardized patients; and is adaptable for in-person teaching. As its goal was to introduce an approach to communicating diagnostic uncertainty, not achieve mastery, students were not individually assessed for proficiency using the Uncertainty Communication Checklist. Students felt the session intervention was valuable.
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Affiliation(s)
- Maria Poluch
- Medical Student, Sidney Kimmel Medical College at Thomas Jefferson University
| | | | - Nethra Ankam
- Associate Professor, Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Jared Kilpatrick
- Medical Education Fellow, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Kenzie Cameron
- Research Professor, Division of General Internal Medicine and Geriatrics, Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Shruti Chandra
- Associate Professor, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Amanda Doty
- Research Coordinator, Department of Emergency Medicine, Thomas Jefferson University
| | - Matthew Klein
- Assistant Professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine
| | - Danielle McCarthy
- Associate Professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine
| | - Kristin Rising
- Associate Professor and Director of Acute Care Transitions, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - David Salzman
- Associate Professor, Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Deborah Ziring
- Clinical Associate Professor, Department of Medicine, and Senior Associate Dean for Academic Affairs, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Dimitrios Papanagnou
- Professor and Vice Chair for Education, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University; Macy Faculty Scholar, Josiah Macy Jr. Foundation
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