Critical Care Communication Skills Training for Internal Medicine Residents

Publication ID Published Volume
10212 September 21, 2015 11


Good communication is at the heart of excellent care for patients and families. At the Beth Israel Deaconess Medical Center Shapiro Institute for Education and Research, we have developed a communication training program for our internal medicine residents. During their intensive care unit (ICU) rotation, residents participate in weekly sessions to learn about key elements for compassionate, effective communication with family members of critically ill patients. These sessions are taught by ICU faculty and by trained volunteers who are former patients or family members of former patients. Residents learn through discussion, role play with feedback, and simulation sessions involving the management of a critically ill patient and related family meetings.

The course focuses on teaching skills needed in initial meetings with families of critically ill patients such as answering family members’ urgent questions, helping them understand and cope with the patient’s illness, and responding to family members’ distress, anger, or sadness. Residents are also taught how to sensitively lead family meetings later in the course of care, especially in discussing important decisions about goals of care when cure is unlikely and the patient’s comfort and quality of life are paramount. Given the three-week ICU rotation, the course is designed to be delivered in three parts over four hours: one-hour sessions for the first two weeks and a two-hour simulation session in the third week. The purpose of this resource is to provide all the materials and instructions needed for clinical faculty to conduct this course at their hospital.

In response to a well-documented need at a national level to improve clinician training and practice in communication with patients and families, a number of thoughtfully designed training programs have been developed to improve residents’ communication skills and practices. However, these programs typically require an extended amount of faculty and resident time away from clinical duties, which is usually not feasible or scalable to a large audience, particularly with tightened duty hours regulations in recent years.

This program addresses a need to deliver efficient and effective training that is seamlessly integrated into daily practice in the intensive care unit (ICU) setting. The Beth Israel Deaconess Medical Center ICU Communication Course accomplishes this by requiring communication training as part of morning house staff rounds for a total of four hours of formal training during the three-week ICU rotation (one hour the first week, one hour the second week, and two hours the third week in the simulation center).

Residents have reported positive responses to the course and have demonstrated improved skills in communication with families of patients in the ICU. Response rate for residents is 98% (n = 137). Residents are 54% male, 69% white, 20% Asian, 4% African American, and 7% other. Prior to training, 97% of residents felt that communication with family members was “very important”; however, few had other communication training during residency, and many felt underprepared for carrying out important communication tasks. After the course, residents reported statistically significant improvements (p < .0001) in preparation to carry out all 17 surveyed skills, with moderate to high effect sizes (e.g., preparation to lead family meetings, 1-5 scale, 2.5-3.5; understanding of appropriate language to use in family communication, 2.5-3.4, p < .0001). Resident attitudes changed as well: Residents were more likely to agree that they wished they could lead more family meetings (pre vs. post: 15.4% vs. 69.3%), more comfortable talking to family about the possibility of death (30.1% vs. 84.6%), and less likely to agree that they dreaded having to deal with the emotional distress of family members of a patient at the end of life (53.8% vs. 23.1%).


Rock L, Gadmer N, Arnold R, et al. Critical care communication skills training for internal medicine residents. MedEdPORTAL Publications. 2015;11:10212.

Educational Objectives

With this resource, course leaders will be able to:

  1. Plan and implement a communication course for residents on rotation in an intensive care unit.

  2. Train volunteers to serve as standardized family members in role plays with residents.

  3. Provide learners with resource materials to learn the communication skills and provide peer feedback.

  4. Assess program outcomes through resident and family member surveys.

After participating in this course, learners will be able to:

  1. Articulate the importance of good communication with families for family well-being, patient care, and physician satisfaction with care.

  2. Demonstrate skills to recognize and respond to family members' emotional reactions by pausing and making an empathic statement.

  3. Demonstrate "ask-tell-ask" when sharing information.

  4. Demonstrate skills to elicit family members' understanding of patient clinical status.

  5. Demonstrate skills to deliver clinical information clearly.

  6. Learn to check in with family members as information is being shared and to explore feelings about new information.

  7. Demonstrate skills to explore patients' values and goals.

  8. Appreciate that every interaction matters.


  • Communication, Critical Care, Intensive Care, Graduate Medical Education, Education, Medical, Graduate, Simulation, Family Meeting


  1. Arnold R, Nelson J. A guide for conducting an ICU family meeting when the patient is unable to participate. Center to Advance Palliative Care Web site. Published 2010.
  2. Back AL, Arnold RM, Quill TE. Hope for the best, and prepare for the worst. Ann Intern Med. 2003;138(5):439-443.
  3. Brandon S. Code Status Discussion Educational Product. MedEdPORTAL Publications; 2013. Available from:
  4. Brown C, Gephardt G, Lloyd C, Swearingen C, Boateng B. Teaching Palliative Care Skills Using Simulated Family Encounters. MedEdPORTAL Publications; 2011. Available from:
  5. Frankel RM, Stein T. Getting the most out of the clinical encounter: the Four Habits model. J Med Pract Manage. 2001;16(4):184-191.
  6. Hallenbeck J. The Stanford Faculty Development Center End-of-Life (ELC) Curriculum. MedEdPORTAL Publications; 2006. Available from:
  7. Han P. The Palliative Care Clinical Evaluation Exercise. MedEdPORTAL Publications; 2006. Available from:
  8. McDonagh JR, Elliott TB, Engelberg RA, et al. Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction. Crit Care Med. 2004;32(7):1484-1488.
  9. Participants in the Bayer–Fetzer Conference on Physician–Patient Communication in Medical Education. Essential elements of communication in medical encounters: the Kalamazoo Consensus Statement. Acad Med. 2001;76(4):390-393.
  10. Quill TE, Arnold R, Back AL. Discussing treatment preferences with patients who want “everything.” Ann Intern Med. 2009;151(5):345-349.
  11. Rao JK, Anderson LA, Sukumar B, Beauchesne DA, Stein T, Frankel RM. Engaging communication experts in a Delphi process to identify patient behaviors that could enhance communication in medical encounters. BMC Health Serv Res. 2010;10(1):97.
  12. Schofield PP, Carey MM, Love AA, Nehill CC, Wein SS. “Would you like to talk about your future treatment options?” Discussing the transition from curative cancer treatment to palliative care. Palliative Med. 2006;20(4):397-406.
  13. Selph RB, Shiang J, Engelberg R, Curtis JR, White DB. Empathy and life support decisions in intensive care units. J Gen Intern Med. 2008;23(9):1311-1317.
  14. van Zuilen M, Caralis P, Granville L. Breaking Bad News: A Small Group Session Teaching Communication Skills for Delivering Bad News. MedEdPORTAL Publications; 2013. Available from:
  15. Williams D, Fisicaro T, Hargraves R, Berg D. End-of-Life Communication Education Program for Internal Medicine Residents. MedEdPORTAL Publications; 2009. Available from:
  16. Wittenberg-Lyles E, Goldsmith J, Ferrell B, Parker Oliver D, Pfeifle A. COMFORT-IPE: Communication Training for Interprofessional Patient-Centered Care. MedEdPORTAL Publications; 2012. Available from:

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