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Chang CH, Suri K, Huang R, Machiorlatti M, Bartl M, Mifuji R. An innovative approach to comprehensive communication skills training for residents: A resident-led communication curriculum. J Investig Med 2023; 71:813-820. [PMID: 37485964 DOI: 10.1177/10815589231190562] [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: 07/25/2023]
Abstract
Innovations to enhance residency training in interpersonal and communication skills are needed and a resident-led strategy has not been well-described. In this study, we explored a resident-led comprehensive communication skills curriculum for internal medicine residents. Residents and faculty prepared the curriculum as part of an Accreditation Council for Graduate Medical Education (ACGME) Back to Bedside Project and with "The language of caring guide for physicians." Employing active learning techniques, three residents led 43 internal medicine residents in seven 1 h sessions from 2019 to 2020. Using a 35-question survey, we assessed pre and post self-reported competence in: mindful practice, collaboration and teamwork, effective openings and closing, communicating with empathy, effective explanations, engaging patients and families as partners, and hard conversations. A Wilcoxon signed rank test was employed to explore differences in median scores after matching each person's pretest and posttest score. The median score for aggregate communication and the scores for all seven competencies assessed improved from pre to post (p < 0.05). This indicates that residents reported higher incidences of performing patient-centered communication skills after the curriculum compared to before. Using a five-point Likert scale, 100% of participants agreed the program improved their communication skills and improved confidence in bedside patient-centered communications. A resident-led comprehensive communication skills curriculum for internal medicine residents was implemented showing improvement in skills over the course of the curriculum. The curriculum was well-accepted by post-survey evaluation and was feasible with motivated resident-leaders, use of an existing guide to communication, and reserved didactic time to implement the program.
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Affiliation(s)
- Chelsea Hook Chang
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Krishna Suri
- Palliative Medicine, Washington Township Medical Foundation, Freemont, CA, USA
| | - Rex Huang
- Yale New Haven Health, Trumbull, CT, USA
| | - Michael Machiorlatti
- Department of Population Health and Biostatistics, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Mery Bartl
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Roque Mifuji
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
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Goyal T, Bereknyei Merrell S, Weimer-Elder B, Kline M, Rassbach CE, Gold CA. A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills. J Palliat Med 2023; 26:1180-1187. [PMID: 36952327 DOI: 10.1089/jpm.2022.0371] [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: 03/24/2023] Open
Abstract
Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p = 0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p = 0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p < 0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.
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Affiliation(s)
- Tarini Goyal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - Barbette Weimer-Elder
- Physician Partnership Program, Patient Experience, Stanford Health Care, Stanford, California, USA
| | - Merisa Kline
- Physician Partnership Program, Patient Experience, Stanford Health Care, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Carl A Gold
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
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Rahim KA, Lakhdir MPA, Afzal N, Merchant AAH, Shaikh NQ, Noorali AA, Tariq U, Ahmad R, Bakhshi SK, Mahmood SBZ, Khan MR, Tariq M, Haider AH. Leveraging the vantage point - exploring nurses' perception of residents' communication skills: a mixed-methods study. BMC MEDICAL EDUCATION 2023; 23:148. [PMID: 36869344 PMCID: PMC9985286 DOI: 10.1186/s12909-023-04114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Effective communication is key to a successful patient-doctor interaction and improved healthcare outcomes. However, communication skills training in residency is often subpar, leading to inadequate patient-physician communication. There is a dearth of studies exploring the observations of nurses - key members of healthcare teams with a special vantage point to observe the impact of residents' communication with patients. Thus, we aimed to gauge the perceptions of nurses regarding residents' communication skills expertise. METHODS This study employed a sequential mixed-methods design, and was conducted at an academic medical center in South Asia. Quantitative data was collected via a REDCap survey using a structured validated questionnaire. Ordinal logistic regression was applied. For qualitative data, In-depth interviews were conducted with nurses using a semi-structured interview guide. RESULTS A total of 193 survey responses were obtained from nurses hailing from various specialties including Family Medicine (n = 16), Surgery (n = 27), Internal Medicine (n = 22), Pediatrics (n = 27), and Obstetrics/Gynecology (n = 93). Nurses rated long working hours, infrastructural deficits, and human failings as the main barriers to effective patient-resident communication. Residents working in in-patient settings were more likely to have inadequate communication skills (P-value = 0.160). Qualitative data analysis of nine in-depth interviews revealed two major themes: existing status-quo of residents' communication skills (including deficient verbal and non-verbal communication, bias in patient counselling and challenging patients) and recommendations for improving patient-resident communication. CONCLUSION The findings from this study highlight significant gaps in patient-resident communication from the perception of nurses and identify the need for creating a holistic curriculum for residents to improve patient-physician interaction.
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Affiliation(s)
- Komal Abdul Rahim
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
- Internal Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
| | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Noreen Afzal
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | | | - Namra Qadeer Shaikh
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Ali Aahil Noorali
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Umar Tariq
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Rida Ahmad
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Saqib Kamran Bakhshi
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Saad Bin Zafar Mahmood
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | | | | | - Adil H Haider
- Medical College, Aga Khan University, Karachi, Pakistan
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Adam P, Mauksch LB, Brandenburg DL, Danner C, Ross VR. Optimal training in communication model (OPTiCOM): A programmatic roadmap. PATIENT EDUCATION AND COUNSELING 2023; 107:107573. [PMID: 36410312 DOI: 10.1016/j.pec.2022.107573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Teaching primary care residents patient communication skills is essential, complex, and impeded by barriers. We find no models guiding faculty how to train residents in the workplace that integrate necessary system components, the science of physician-patient communication training and competency-based medical education. The aim of this project is to create such a model. METHODS We created OPTiCOM using four steps: (1) communication educator interviews, analysis and theme development; (2) initial model construction; (3) model refinement using expert feedback; (4) structured literature review to validate, refine and finalize the model. RESULTS Our model contains ten interdependent building blocks organized into four developmental tiers. The Foundational value tier has one building block Naming relationship as a core value. The Expertize and resources tier includes four building blocks addressing: Curricular expertize, Curricular content, Leadership, and Time. The four building blocks in the Application and development tier are Observation form, Faculty development, Technology, and Formative assessment. The Language and culture tier identifies the final building block, Culture promoting continuous improvement in teaching communication. CONCLUSIONS OPTiCOM organizes ten interdependent systems building blocks to maximize and sustain resident learning of communication skills. Practice Implications Residency faculty can use OPTiCOM for self-assessment, program creation and revision.
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Affiliation(s)
- Patricia Adam
- Department of Family Medicine and Community Health, University of Minnesota, Smiley's Clinic, 2020 East 28th Street, Minneapolis, MN 55407, USA.
| | - Larry B Mauksch
- Emeritus - Department of Family Medicine, University of Washington, Home, 6026 30th Ave NE, Seattle, WA 98115, USA.
| | - Dana L Brandenburg
- Department of Family Medicine and Community Health, University of Minnesota, Smiley's Clinic, 2020 East 28th Street, Minneapolis, MN 55407, USA.
| | - Christine Danner
- Department of Family Medicine and Community Health, University of Minnesota, Bethesda Clinic, 580 Rice St, St Paul, MN 55103, USA.
| | - Valerie R Ross
- University of Washington Department of Family Medicine, Family Medicine Residency Program, Box 356390, 331 N.E. Thornton Place, Seattle, WA 98125, USA.
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Bylund CL, Vasquez TS, Peterson EB, Ansell M, Bylund KC, Ditton-Phare P, Hines A, Manna R, Singh Ospina N, Wells R, Rosenbaum ME. Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees' Communication Behaviors: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1854-1866. [PMID: 35857395 PMCID: PMC9712157 DOI: 10.1097/acm.0000000000004883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors. METHOD Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. RESULTS Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. CONCLUSIONS This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.
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Affiliation(s)
- Carma L Bylund
- C.L. Bylund is professor, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Taylor S Vasquez
- T.S. Vasquez is a doctoral student, Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, Florida
| | - Emily B Peterson
- E.B. Peterson is senior research analyst, University of Southern California, Los Angeles, California
| | - Margaret Ansell
- M. Ansell is associate university librarian and associate chair, Health Science Center Libraries, University of Florida, Gainesville, Florida
| | - Kevin C Bylund
- K.C. Bylund is associate professor, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Philippa Ditton-Phare
- P. Ditton-Phare is medical education support officer (psychiatry), Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - April Hines
- A. Hines is journalism and mass communications librarian, George A. Smathers Libraries, University of Florida, Gainesville, Florida
| | - Ruth Manna
- R. Manna is associate director, Patient Experience Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naykky Singh Ospina
- N. Singh Ospina is associate professor, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Robert Wells
- R. Wells is science writer, Office of Research, University of Central Florida, Orlando, Florida
| | - Marcy E Rosenbaum
- M.E. Rosenbaum is professor, Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Jiang YG, Colaco M, Hu XP, Atala A, Zhang XD, Zhang JH, Zhao WX. Comparison of urology residency training between the United States and China. Actas Urol Esp 2022; 46:367-376. [PMID: 35260372 DOI: 10.1016/j.acuroe.2022.02.002] [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] [Received: 11/16/2020] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study compares the present status and traits of urology residency programs in the United States and China. METHODS The flow path, structure, curriculum, operative experience, scholarly activities, evaluation systems and other aspects of training were comparatively evaluated between China and the United States. RESULTS Urology residency training programs are different between China and the United States in many aspects. Admission requirements for the United States urology residency program are more rigorous, and the specialty training program in the United States is more concentrated. Furthermore, residency programs in USA have much more practical clinical and research training, and their evaluation process is more diverse, and it has been designed to assess competencies. Moreover, job opportunities after residency substantially differ between these two countries. Becoming an independent urologic surgeon is not the specific goal of the Urology residency training program in China, and it would require more training time than in the United States. CONCLUSION Urology residency training programs in the United States and China have a unique format and characteristics. The training programs in China are focused on general techniques and procedures, while training programs in USA follow a more standardized curriculum. Both USA and China may complement each other to create training programs that would ultimately provide high-quality patient care.
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Affiliation(s)
- Y G Jiang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - M Colaco
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, School of Medicine, North Carolina, USA
| | - X P Hu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - A Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, School of Medicine, North Carolina, USA
| | - X D Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - J H Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - W X Zhao
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, School of Medicine, North Carolina, USA.
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Comparación de los programas de residencia en urología de Estados Unidos y China. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Howell HB, Desai PV, Altshuler L, McGrath M, Ramsey R, Vrablik L, Levy FH, Zabar S. Teaching and Assessing Communication Skills in Pediatric Residents: How Do Parents Think We Are Doing? Acad Pediatr 2022; 22:179-183. [PMID: 34186252 DOI: 10.1016/j.acap.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Curricula designed to teach and assess the communication skills of pediatric residents variably integrates the parent perspective. We compared pediatric residents' communication skills in an objective structured clinical exam (OSCE) case as assessed by Family Faculty (FF), parents of pediatric patients, versus standardized patients (SP). METHODS Residents participated in an OSCE case with a SP acting as a patient's parent. We compared resident performance as assessed by FF and SP with a behaviorally-anchored checklist. Items were rated as not done, partly done or well done, with well-done indicating mastery. The residents evaluated the experience. RESULTS 42 residents consented to study participation. FF assessed a lower percentage of residents as demonstrating skill mastery as compared to SP in 19 of the 23 behaviors. There was a significant difference between FF and SP for Total Mastery Score and Mastery of the Competency Scores in three domains (Respect and Value, Information Sharing and Participation in Care and Decision Making). The majority of residents evaluated the experience favorably. CONCLUSION Involving parents of pediatric patients in the instructive and assessment components of a communication curriculum for pediatric residents adds a unique perspective and integrates the true stakeholders in parent-physician communication.
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Affiliation(s)
- Heather B Howell
- Department of Pediatrics, New York University Grossman School of Medicine (HB Howell, PV Desai, L Vrablik, and FH Levy), New York, NY.
| | - Purnahamsi V Desai
- Department of Pediatrics, New York University Grossman School of Medicine (HB Howell, PV Desai, L Vrablik, and FH Levy), New York, NY
| | - Lisa Altshuler
- Department of Medicine, New York University Grossman School of Medicine (L Altshuler and S Zabar), New York, NY
| | - Meaghan McGrath
- Sala Institute for Child and Family Centered Care, Hassenfeld Children's Hospital (M McGrath, R Ramsey and FH Levy), New York, NY
| | - Rachel Ramsey
- Sala Institute for Child and Family Centered Care, Hassenfeld Children's Hospital (M McGrath, R Ramsey and FH Levy), New York, NY
| | - Lauren Vrablik
- Department of Pediatrics, New York University Grossman School of Medicine (HB Howell, PV Desai, L Vrablik, and FH Levy), New York, NY
| | - Fiona H Levy
- Department of Pediatrics, New York University Grossman School of Medicine (HB Howell, PV Desai, L Vrablik, and FH Levy), New York, NY; Sala Institute for Child and Family Centered Care, Hassenfeld Children's Hospital (M McGrath, R Ramsey and FH Levy), New York, NY
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine (L Altshuler and S Zabar), New York, NY
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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Allen TC, Smith PO. Establishing a Professionalism and Communication Curriculum at the University of Mississippi Medical Center Department of Pathology. Arch Pathol Lab Med 2021; 146:11-15. [PMID: 34437682 DOI: 10.5858/arpa.2021-0138-ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/06/2022]
Affiliation(s)
| | - Patrick O Smith
- Office of Faculty Affairs (Smith), The University of Mississippi Medical Center, Jackson
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Papanagnou D, Klein MR, Zhang XC, Cameron KA, Doty A, McCarthy DM, Rising KL, Salzman DH. Developing standardized patient-based cases for communication training: lessons learned from training residents to communicate diagnostic uncertainty. Adv Simul (Lond) 2021; 6:26. [PMID: 34294153 PMCID: PMC8296470 DOI: 10.1186/s41077-021-00176-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/18/2021] [Indexed: 12/01/2022] Open
Abstract
Health professions education has benefitted from standardized patient (SP) programs to develop and refine communication and interpersonal skills in trainees. Effective case design is essential to ensure an SP encounter successfully meets learning objectives that are focused on communication skills. Creative, well-designed case scenarios offer learners the opportunity to engage in complex patient encounters, while challenging them to address the personal and emotional contexts in which their patients are situated. Therefore, prior to considering the practical execution of the patient encounter, educators will first need a clear and structured strategy for writing, organizing, and developing cases. The authors reflect on lessons learned in developing standardized patient-based cases to train learners to communicate to patients during times of diagnostic uncertainty, and provide suggestions to develop a set of simulation cases that are both standardized and diverse. Key steps and workflow processes that can assist educators with case design are introduced. The authors review the need to increase awareness of and mitigate existing norms and implicit biases, while maximizing variation in patient diversity. Opportunities to leverage the breadth of emotional dispositions of the SP and the affective domain of a clinical encounter are also discussed as a means to guide future case development and maximize the value of a case for its respective learning outcomes.
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Affiliation(s)
- Dimitrios Papanagnou
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Room 101, Philadelphia, PA, 19107, USA.
| | - Matthew R Klein
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xiao Chi Zhang
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Room 101, Philadelphia, PA, 19107, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics/Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda Doty
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Room 101, Philadelphia, PA, 19107, USA
| | - David H Salzman
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Marsh MC, Reed SM, Mahan JD, Schneider L, Fernandes AK, Liao N, Spears I, Lauden S. Advanced Multimodal Communication Curriculum for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211035239. [PMID: 34869900 PMCID: PMC8642051 DOI: 10.1177/23821205211035239] [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: 03/09/2021] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical educators juggle competing demands as they seek to integrate medical advancements and new technology with the call for earlier introduction to clinical experiences. Newer models of medical education place even greater emphasis on the importance of deliberate training of providers who can deliver compassionate patient-centered care. The need for adaptable, effective communication skills training has never been more relevant than now, in our high-tech and ever-evolving learning climate. METHODS At a large pediatric academic center, we used Kern's six-step approach to complete a needs assessment, identify goals and learning preferences of trainees, and ultimately develop and evaluate a multimodal communication curriculum. This curriculum was rooted in the Accreditation Council for Graduate Medical Education's Pediatric Milestones, with the goal of enhancing knowledge, skills, and competency. Pediatric interns were randomized to either the new curriculum (n = 19) or the existing didactic-based communication training (n = 17) from 2019 to 2020. We evaluated the impact of the new and traditional curriculum through evaluations by expert facilitators, learner surveys, and faculty-assigned resident milestones. RESULTS Many trainees self-identified performance gaps in communication skills at baseline. Eighteen residents attended 1 to 6 in-person deliberate practice workshops. Workshop participation by the residents varied over time due to a variety of factors. All residents, regardless of curricular exposure, showed statistically significant improvement in communication milestones from first to second year and those enrolled in the deliberate practice curriculum highly valued the workshops and coaching. DISCUSSION Our curriculum demonstrates the value of deliberate practice opportunities for residents to gain skills in advanced communication. Residents appreciated this type of training and the time devoted to expand these skills. Lessons learned and barriers to implementation from this curriculum can be helpful for educators interested in integrating active, deliberate practice, simulation-based communication training into their current educational model.
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Affiliation(s)
| | | | - John D Mahan
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH,
USA
| | - Lydia Schneider
- The Ohio State University College of Medicine, Columbus, OH,
USA
| | - Ashley K Fernandes
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH,
USA
| | - Nancy Liao
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Isaac Spears
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH,
USA
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13
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Howell EP, Fischer J, Valea FA, Davidson BA. Communication Matters: a Survey Study of Communication Didactics in Obstetrics/Gynecology Residency. MEDICAL SCIENCE EDUCATOR 2020; 30:1069-1076. [PMID: 34457769 PMCID: PMC8368866 DOI: 10.1007/s40670-020-01017-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Delivery of excellent patient care hinges on effective communication. Improved communication between physicians, patients, and colleagues can facilitate shared decision-making and foster successful interprofessional teams. Despite the importance of this skill, little is understood about the status or acceptability of dedicated communication training during obstetrics and gynecology (OB/GYN) residency. OBJECTIVE To explore the national landscape of dedicated communication didactics during OB/GYN training. METHODS Residents and program directors (PDs) at ACGME-accredited programs were emailed anonymized surveys. Survey responses pertaining to communication didactics and trainee experiences were evaluated using descriptive statistics and chi-squared tests. RESULTS Of 143 PDs, 45 responded (31.5%). Although the total number of residents receiving our survey is unattainable, our 215 resident respondents can be estimated to represent at least 4.4% of trainees. 98.1% of residents reported challenging clinical communication at least monthly, with many reporting this weekly (47.9%) and daily (30.0%). A majority of PDs (77.8%) and residents (67.0%) endorsed interest in communication training. 62.2% of programs reported formally teaching communication skills. Certain topics were infrequently taught yet cited by residents as particularly challenging-such as "diffusing conflict" and "angry patient or family members." PDs tended to significantly overestimate trainee competence in conducting difficult conversations with both patients (p = 0.0003) and interdisciplinary colleagues (p < 0.0001), as compared with resident self-assessments. CONCLUSIONS Residents encounter frequent challenging communications interactions, and often feel inadequately equipped to navigate them. Dedicated didactics may provide a critical component to optimally educating of the next generation of trainees within OB/GYN and more broadly.
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Affiliation(s)
- Elizabeth P. Howell
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC USA
| | - Jonathan Fischer
- Department of Family Medicine and Community Health, Duke University, Durham, NC USA
| | - Fidel A. Valea
- Department of Obstetrics and Gynecology, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Brittany A. Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, DUMC Box 3079, Durham, NC 27710 USA
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Jones AH, Jacobs MB, October TW. Communication Skills and Practices Vary by Clinician Type. Hosp Pediatr 2020; 10:325-330. [PMID: 32132113 DOI: 10.1542/hpeds.2019-0262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Unscheduled admission to the PICU is a stressful experience for families. During the admission process, families communicate with 4 types of clinicians (resident, nurse practitioner, fellow, and attending physician). All clinicians must manage family stress while communicating concise, accurate information. The manner and variability in how different clinicians communicate with families at the time of PICU admission is not yet known. METHODS We performed a prospective observational study to evaluate communication patterns of various clinician types, including the length of communication encounters and the number of provider interruptions at the time of admission to the PICU during a 3-month period. All nonscheduled admissions to the PICU were eligible for enrollment. The admission intake was audio recorded and directly observed. RESULTS We observed 45 different family-clinician interactions for a total of 19 unique family encounters (48% of eligible admissions). Residents and nurse practitioners spent the most time communicating with families (14.3 and 19 minutes, respectively) compared with fellows (7.3 minutes) and attending physicians (6.6 minutes). Residents were frequently interrupted by pages and phone calls (64% of interactions) and spoke at a higher reading level than all other clinician types (P = .03; 95% confidence interval 74.6-83.9). Qualitatively, residents had more challenges coping with distractions, acknowledging parental emotions, and aligning with parental goals compared with other clinician types. CONCLUSIONS Resident trainees spend significantly more time with families and, during this time, are burdened with frequent interruptions. In this stressful communication environment, residents encounter more barriers to communication and may require additional communication skills to manage relaying complex information while simultaneously responding to parental emotions.
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Affiliation(s)
- Amy H Jones
- Departments of Critical Care Medicine and .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Marni B Jacobs
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.,Biostatistics and Study Methodology, Children's Research Institute, Children's National Hospital, Washington, District of Columbia; and
| | - Tessie W October
- Departments of Critical Care Medicine and.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
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Reed S, Frey-Vogel A, Frost M. Look Who's Talking: A Survey of Pediatric Program Directors on Communication Skills Education in Pediatric Residency Programs. Acad Pediatr 2020; 20:9-13. [PMID: 31103882 DOI: 10.1016/j.acap.2019.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine current practices for communication skills curriculum and assessment in pediatric residency programs and to identify programs' greatest needs regarding communication curricula and assessment. METHODS We surveyed pediatric residency program directors about their programs' approach to teaching and assessing residents' communication skills and how satisfied they were with their curricula and assessment of competence. Respondents were asked about their programs' greatest needs for teaching and assessing communication skills. RESULTS Response rate was 41% (82/202). Most programs did teach communication skills to residents; only 14% provided no formal training. Programs identified various 1) educational formats for teaching communication skills, 2) curricular content, and 3) assessment methods for determining competence. Many programs were less than satisfied with their curriculum and the accuracy of their assessments. The greatest programmatic need regarding curricula was time, while the greatest need for assessment was a tool. CONCLUSIONS While teaching and assessment of communication skills is common in pediatric residency programs, it is inconsistent and variable, and many programs are not satisfied with their current communication training. There is need for development of and access to appropriate and useful curricula as well as a practical tool for assessment which has been evaluated for validity evidence.
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Affiliation(s)
- Suzanne Reed
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus (S Reed); Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, Boston, Mass (A Frey-Vogel); Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (M Frost).
| | - Ariel Frey-Vogel
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus (S Reed); Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, Boston, Mass (A Frey-Vogel); Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (M Frost)
| | - Mackenzie Frost
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus (S Reed); Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, Boston, Mass (A Frey-Vogel); Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (M Frost)
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Collins K, Hopkins A, Shilkofski NA, Levine RB, Hernandez RG. Difficult Patient Encounters: Assessing Pediatric Residents' Communication Skills Training Needs. Cureus 2018; 10:e3340. [PMID: 30473973 PMCID: PMC6248659 DOI: 10.7759/cureus.3340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Difficult patient encounters (DPEs) are common and can lead to frustration and dissatisfaction among healthcare providers. Pediatric resident physician experiences with DPEs and curricula for enhancing necessary communication skills have not been well described. Materials and methods We used a cross-sectional survey research design for our needs assessment on resident experiences with DPEs. Thirty-three pediatric residents completed this anonymous survey. The survey assessed residents’ experiences with and self-efficacy regarding DPEs. Descriptive statistics were used to analyze the quantitative data. Additionally, two authors independently coded free response data to include in the narrative description of the survey results. Results These survey results include the views of 92% of the residents in the program (33/36). Residents reported a greater frequency of difficult encounters in the inpatient setting than the outpatient setting. The majority of residents rated their communication skills during DPEs as “fair” or “good” (70%, 23/33). Residents tended to have lower confidence when discussing chronic pain, managing parental insistence on a plan, and breaking bad news. They generally reported higher levels of anxiety for scenarios involving angry patients and families, families insisting on a plan, and when breaking bad news. Residents cited many challenges, including working with angry and demanding families. Additionally, residents described difficulty with managing discordant opinions between the family and the healthcare team regarding the care plan. Residents expressed a preference for learning how to manage challenging patient encounters using clinical experiences. Simulation, discussion, and observation of role models also rated highly as educational methods for increasing skills, while most residents rated lectures as the least important means of training skills for these difficult encounters. Discussion We found that pediatric residents experience difficult encounters frequently, especially in the inpatient setting. Individual residents vary in their confidence and anxiety levels with different types of difficult encounters and may benefit from not only general communication skills training, but also from targeted training to equip them for the particular contexts they find most challenging. Residents value interactive structured learning activities, including discussion and simulation. Residents most consistently value the opportunity to lead challenging conversations in the clinical setting, especially when followed by effective debriefing and feedback by trained faculty preceptors. Conclusions Next steps include creating a “Difficult Encounters” communication skills curriculum informed by this needs assessment, which aim to enhance patient care as well as increase resident self-efficacy. In addition to the curriculum development for residents, it may be helpful to initiate faculty development on how to supervise resident-led difficult conversations and provide effective debriefing and feedback to promote resident growth.
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Affiliation(s)
- Kimberly Collins
- General Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Akshata Hopkins
- General Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Nicole A Shilkofski
- General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Rachel B Levine
- Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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March C. Experiential Communications Curriculum to Improve Resident Preparedness When Responding to Discriminatory Comments in the Workplace. J Grad Med Educ 2018; 10:306-310. [PMID: 29946388 PMCID: PMC6008033 DOI: 10.4300/jgme-d-17-00913.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/08/2018] [Accepted: 03/14/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients and families can make discriminatory comments leading to physician distress. Residents receive little training in appropriate responses to such comments and may be ill equipped to respond to intolerance without alienating the individual(s) making the comments. OBJECTIVE We assessed whether a simulated curriculum would enhance pediatrics residents' ability to effectively respond to discriminatory comments. METHODS In the 2016-2017 academic year, we modified an existing communication skills curriculum for senior pediatrics residents. Residents engaged a simulated parent who used discriminatory speech in 4 scenarios, followed by a group debriefing. We conducted anonymous surveys to assess residents' preparedness to respond to these comments before and immediately following participation and examined their experience with discriminatory comments in the workplace. RESULTS The majority of residents reported prior experience with discriminatory comments (32 of 45 [71%] witnessed such comments, and 27 of 48 [56%] were targeted by such comments), most often regarding age, race, and ethnicity. Mean precourse scores ranged from 2.1 to 3.1 (on a 5-point scale) regarding ability to engage in a firm yet respectful dialogue, to reference the hospital code of conduct, to coach a learner to respond, and to facilitate a team debrief. Mean postcourse scores improved significantly for these questions (range 3.8-4.1). The greatest improvement was in referencing the code of conduct (2.1 versus 4.0, P < .001). CONCLUSIONS Immediately after participating in simulation, pediatrics residents reported a significant improvement in self-reported readiness to respond to discriminatory comments made by a parent and reported the simulation experience was beneficial.
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Arigliani M, Castriotta L, Pusiol A, Titolo A, Petoello E, Brun Peressut A, Miorin E, Elkina I, Marzona F, Cucchiaro D, Spanghero E, Pavan M, Arigliani R, Mercer SW, Cogo P. Measuring empathy in pediatrics: validation of the Visual CARE measure. BMC Pediatr 2018; 18:57. [PMID: 29439733 PMCID: PMC5812057 DOI: 10.1186/s12887-018-1050-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/06/2018] [Indexed: 12/30/2022] Open
Abstract
Background Empathy is a key element of “Patient and Family Centered Care”, a clinical approach recommended by the American Academy of Pediatrics. However, there is a lack of validated tools to evaluate paediatrician empathy. This study aimed to validate the Visual CARE Measure, a patient rated questionnaire measuring physician empathy, in the setting of a Pediatric Emergency Department (ED). Methods The empathy of physicians working in the Pediatric ED of the University Hospital of Udine, Italy, was assessed using an Italian translation of the Visual Care Measure. This test has three versions suited to different age groups: the 5Q questionnaire was administered to children aged 7–11, the 10Q version to those older than 11, and the 10Q–Parent questionnaire to parents of children younger than 7. The internal reliability, homogeneity and construct validity of the 5Q and 10Q/10Q–Parent versions of the Visual Care Measure, were separately assessed. The influence of family background on the rating of physician empathy and satisfaction with the clinical encounter was also evaluated. Results Seven physicians and 416 children and their parents were included in the study. Internal consistency measured by Cronbach’s alpha was 0.95 for the 10Q/10Q–Parent versions and 0.88 for the 5Q version. The item-total correlation was > 0.75 for each item. An exploratory factor analysis showed that all the items load onto the first factor. Physicians’ empathy scores correlated with patients’ satisfaction for both the 10Q and 10Q–Parent questionnaires (Spearman’s rho = 0.7189; p < 0.001) and for the 5Q questionnaire (Spearman’s rho = 0.5968; p < 0,001). Trust in the consulting physician was lower among immigrant parents (OR 0.43. 95% CI 0.20–0.93). Conclusions The Visual Care Measure is a reliable second-person test of physician empathy in the setting of a Pediatric Emergency Room. More studies are needed to evaluate the reliability of this instrument in other pediatric settings distinct from the Emergency Room and to further evaluate its utility in measuring the impact of communication and empathy training programmes for healthcare professionals working in pediatrics.
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Affiliation(s)
- Michele Arigliani
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy.
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, ASUI Udine, Istituto Igiene, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Anna Pusiol
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Annachiara Titolo
- University of Udine School of Medicine, Piazzale M. Kolbe, 3 - 33100 Udine, 33100, Udine, Italy
| | - Enrico Petoello
- University of Udine School of Medicine, Piazzale M. Kolbe, 3 - 33100 Udine, 33100, Udine, Italy
| | - Alberto Brun Peressut
- Department of Surgery, University Hospital of Udine, ASUI Udine, Clinica Chirurgica, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Elisabetta Miorin
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Iana Elkina
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Federico Marzona
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Davide Cucchiaro
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Elisa Spanghero
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Matteo Pavan
- University of Trieste, Facoltà di Medicina e Chirurgia dell'Università degli Studi di Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Raffaele Arigliani
- Pediatric Primary Care, ASL Benevento, Via Giuseppe Piermarini, 12, 82100, Benevento, Italy
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - Paola Cogo
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
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