Clear conversations: A comprehensive curriculum to facilitate translation of skills learned in simulated settings to improve communication in real clinical encounters

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Conference Proceeding

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Publication Title

J Pain Symptom Manage


Objectives: Apply a protocol for deliberate practice of communication skills in real encounters with the aid of a mobile app and online template. Demonstrate at least two communication skills learned in simulation (eg, ask-tell-ask, empathic response, open-ended question to elicit patient values) in a real clinical encounter. Background. Communication skills training with simulated patients has gained traction in many academic centers as a way to improve communication skills. However, the optimal method to facilitate translation of skills learned in simulated settings to improve communication in real clinical encounters has not been described. Methods. We developed a comprehensive communication skills curriculum for physicians in the ICU that consists of (1) simulation-based communication skills workshops for ICU fellows, residents, and attending physicians; (2) standardized pre- and postfamily meeting team huddles following a template in a mobile app, which includes setting a communication goal and getting specific feedback; (3) online evaluation template to record family meeting feedback as a procedure; and (4) mandatory family meetings within 72 hours for all patients in the ICU with APACHE IV mortality >30%. We conducted a prospective cohort 2-week pilot study. We implemented the curriculum in one ICU unit and compared it to another geographically distinct ICU unit where the attending, fellow, and residents had not received simulation training or training on other aspects of the curriculum. Our main outcome measure was family satisfaction with physician communication in the ICU using a 10-question modified HCAPS survey. A secondary outcome was trainee self-perceived preparedness for end-of-life communication tasks in the ICU pre and post intervention. Results. Patients in the intervention group (n=15) scored significantly higher on satisfaction with physician communication than the control group (n=16) (p=0.0178). Trainees in the intervention group showed significant improvement in self-perceived preparedness in communication skills between pre and post intervention in expressing empathy, responding to families who deny the seriousness of their loved one's illness, and discussing spiritual issues. There were no significant differences pre and post intervention in the control group. Discussion. This comprehensive communication curriculum combining simulation-based training, deliberate practice at the bedside with the aid of a mobile app and online evaluation template, and mandatory early family meetings for high risk patients was associated with improved patient satisfaction with physician communication in the ICU and increased trainee preparedness for difficult communication tasks. Conclusion. This communication curriculum could serve as a model for optimal inpatient communication skills training for residents and fellows across all disciplines.





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