Original Publication
Open Access

Critical Care Communication Skills Training for Internal Medicine Residents

Published: September 21, 2015 | 10.15766/mep_2374-8265.10212

Included in this publication:

  • Attendance Sheet.dotx
  • Communication Guide.pdf
  • Family Member Survey.pdf
  • Instructor's Guide.pdf
  • Instructor's Manual.pdf
  • Patient Case & Resident Sign-out - Simulation Session.docx
  • Patient Case - Sessions 1 & 2.docx
  • Reflective Writing Worksheet.docx
  • Resident Survey Pre.docx
  • Resident Survey T1.doc
  • Resident Survey T2.doc
  • Responding to Emotion Handout.pdf
  • Session Plans.pdf
  • Volunteer Survey.doc
  • Volunteer Training Materials for trainers.pdf
  • Volunteer Training Materials for volunteers.pdf

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

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. 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 3-week ICU rotation, the course is designed to be delivered in three parts over 4 hours: 1-hour sessions for the first 2 weeks and a 2-hour simulation session in the third week. 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 any 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%).


Educational Objectives

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.

Author Information

  • Laura Rock, MD: Beth Israel Deaconess Medical Center
  • Nina Gadmer, RN: Beth Israel Deaconess Medical Center
  • Robert Arnold, MD: University of Pittsburgh School of Medicine
  • David Roberts, MD: Beth Israel Deaconess Medical Center
  • Asha Anandaiah, MD: Beth Israel Deaconess Medical Center
  • Melanie Pogach, MD: Beth Israel Deaconess Medical Center
  • Peter Clardy, MD: Beth Israel Deaconess Medical Center
  • Richard Schwartzstein, MD: Beth Israel Deaconess Medical Center
  • Amy Sullivan, EdD: Beth Israel Deaconess Medical Center

Disclosures
None to report.

Funding/Support
None to report.


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Citation

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