Critical Care Communication Skills Training for Internal Medicine Residents

Publication ID Published Volume
10212 September 21, 2015 11

Abstract

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%).

Citation

Rock L, Gadmer N, Arnold R, et al. Critical care communication skills training for internal medicine residents. MedEdPORTAL Publications. 2015;11:10212. http://doi.org/10.15766/mep_2374-8265.10212

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.

Keywords

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

References

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