Communicating a Plan for Involuntary Psychiatric Admission: A Standardized Patient Workshop Intervention for General Psychiatry Residents

Introduction

One important and often difficult act of communication common in psychiatry is communication regarding the need for involuntarily commitment for psychiatric treatment. Thus, we designed an educational workshop for psychiatry residents on how to communicate the plan for involuntarily commitment to a psychiatric hospital.

Methods

Using faculty expertise, we created a protocol to guide trainees on how to structure conversations around involuntary commitment. Residents first attended a didactic on the protocol, followed by a 1-hour workshop with standardized patients (SPs) 1 week later. The workshop consisted of three 14-minute simulated scenarios with the SP with debriefing. Trainees filled out pre- and postworkshop surveys.

Results

Fifteen and 12 residents completed the pre- and postworkshop surveys, respectively. Residents' perceived comfort level in their ability to deliver involuntary commitment news significantly improved after the workshop when compared to before (3.0 vs. 3.7 for pre- and postworkshop surveys, respectively). Residents trended toward intending to make more changes to their approach after the workshop when compared to before (2.2 vs. 2.6, respectively). Feedback on the didactic and workshop were largely positive.

Discussion

To our knowledge, our intervention is the first designed specifically to teach psychiatry residents how to communicate to patients that they are being involuntarily committed to emergent psychiatric treatment. This educational model has potential for improving resident skills and confidence in having difficult conversations around involuntary commitment.

Delivering Difficult News and Improving Family Communication: Simulation for Neonatal-Perinatal Fellows

INTRODUCTION

This 3-hour simulation module provides a safe situation for neonatal-perinatal fellows to learn communication techniques and develop skills for delivering difficult news to patients' families. These skills are critical for a practicing neonatologist in an academic or private-practice setting yet are often underrepresented in the educational content of training programs. This module is intended for fellows who have had basic communication skills instruction, as well as interactions with parents as part of their pediatric residency training.

METHODS

The fellows practice delivering difficult news by interacting with standardized parents in scenarios designed for one to three learners at a time. Each scenario runs for approximately 10 to 15 minutes and is followed by a 25- to 30-minute debriefing. Those not participating in the scenario view the simulation in real-time video broadcast from another room so they can learn from the scenario and participate in the debriefing. The module also includes 10 to 15 minutes for discussion of literature. This publication includes an introductory slide presentation and a comprehensive compilation of communication recommendations from attending neonatologists. Also included are scripts for the standardized parents, background information for learners, guidelines and suggestions for discussion during the debriefing, and an evaluation form.

RESULTS

This module has been incorporated into the yearly simulation curriculum for our neonatal-perinatal fellowship. After completing the module, fellows have reported feeling more comfortable with delivering difficult news. The average score in fellows' comfort level for having these conversations rose from 5.8 to 7.5 on a 10-point scale.

DISCUSSION

This module was designed for use in a perinatal-neonatal fellowship training program, but it could be used in all pediatric residencies, as well as for support staff training (social work, nursing, chaplaincy) with the use of a confederate physician.

Pediatric Boot Camp Series: Obtaining a Consult, Discussing Difficult News

INTRODUCTION

Transitioning from medical student to intern requires individuals to possess medical knowledge, clinical skills, and the ability to communicate with a wide variety of health care professional as well as patients and their families. New doctors may be expected to function within the health care team without having received explicit instruction in communication previously. The materials associated with this publication are intended to be used as resources for small-group education of graduating medical students entering into pediatric, family medicine, or emergency medicine residencies.

METHODS

Four pediatric cases serve as the focus points for discussion and role-play around calling consultants and discussing difficult news with families and patients. Brief didactics and detailed facilitator notes help prime learning and guide discussion. The included facilitator notes and slide sets are part of the comprehensive materials necessary to implement this 4-hour course at your own institution.

RESULTS

This curriculum has been used since 2012 with graduating medical students entering into pediatric, family medicine, and emergency medicine residencies at two institutions within the United States. Feedback has been overwhelmingly positive, and students have reported increased confidence in their ability to communicate with families and other health care providers.

DISCUSSION

This publication is the second part of a two-part curriculum but may be used independently of the first part. Although the cases are based on pediatrics, the content regarding communication is universal to many medical specialties.