Teaching residents how to break bad news: piloting a resident-led curriculum and feedback task force as a proof-of-concept study

2021 ◽  
pp. bmjstel-2021-000897
Author(s):  
Joseph Sleiman ◽  
David J Savage ◽  
Benjamin Switzer ◽  
Colleen Y Colbert ◽  
Cory Chevalier ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Communication Skills ◽  
Task Force ◽  
Educational Innovation ◽  
Field Testing ◽  
Bad News ◽  
Two Phase ◽  
Academic Medical Centre ◽  
Internal Medicine Residents ◽  
Survey Results

BackgroundBreaking bad news (BBN) is a critically important skill set for residents. Limited formal supervision and unpredictable timing of bad news delivery serve as barriers to the exchange of meaningful feedback.Purpose of studyThe goal of this educational innovation was to improve internal medicine residents’ communication skills during challenging BBN encounters. A formal BBN training programme and innovative on-demand task force were part of this two-phase project.Study designInternal medicine residents at a large academic medical centre participated in an interactive workshop focused on BBN. Workshop survey results served as a needs assessment for the development of a novel resident-led BBN task force. The task force was created to provide observations at the bedside and feedback after BBN encounters. Training of task force members incorporated video triggers and a feedback checklist. Inter-rater reliability was analysed prior to field testing, which provided data on real-world implementation challenges.Results148 residents were trained during the 2-hour communications skills workshop. Based on survey results, 73% (108 of 148) of the residents indicated enhanced confidence in BBN after participation. Field testing of the task force on a hospital ward revealed potential workflow barriers for residents requesting observations and prompted troubleshooting. Solutions were implemented based on field testing results.ConclusionsA trainee-led BBN task force and communication skills workshop is offered as an innovative model for improving residents’ interpersonal and communication skills in BBN. We believe the model is both sustainable and reproducible. Lessons learnt are offered to aid in implementation in other settings.

Critical Care Communication Skills Training for Internal Medicine Residents

MedEdPORTAL ◽  
2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Rock ◽  
Nina Gadmer ◽  
Robert Arnold ◽  
David Roberts ◽  
Asha Anandaiah ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Communication Skills ◽  
Skills Training ◽  
Communication Skills Training ◽  
Internal Medicine Residents

scholarly journals 1947. Educational Impact of a Hybrid Infectious Diseases Rotation for Internal Medicine Residents

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S57-S57
Author(s):  
James B Cutrell ◽  
James B Cutrell ◽  
Binh-Minh Le ◽  
Heather R Wolfe ◽  
Helen King ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Infectious Diseases ◽  
Educational Innovation ◽  
Mobile App ◽  
Curriculum Innovation ◽  
Educational Impact ◽  
Educational Innovations ◽  
Clinical Exposure ◽  
Internal Medicine Residents ◽  
Board Review

Abstract Background Traditional infectious diseases (ID) rotations for internal medicine (IM) residents focus on inpatient consultation, potentially skewing trainees’ perspectives on ID. We report our experience with a hybrid inpatient–outpatient ID rotation which provides broader ID clinical exposure and an effective venue for educational innovation. Methods We included all IM residents completing an assigned ID rotation in the UT Southwestern IM residency since July 2013. From July 2013 to June 2017, a 4-week ambulatory ID (Amb ID) rotation, consisting of general and subspecialty ID clinics and weekly teaching sessions focused on ID board review, was offered in parallel to traditional inpatient ID consult rotations. From July 2017 to present, all assigned residents complete up to a 4-week ID hybrid rotation, consisting of 2 weeks of ambulatory ID and 2 weeks of inpatient ID consults, with all residents receiving weekly teaching sessions; in some cases, the 4 weeks were not completed sequentially. Data were collected on resident numbers and training level, quantitative and qualitative course evaluations, and program in-training examination scores in ID content areas. Results From July 2013 to June 2019, IM residents completed a total of 626 ID rotations, an average of 104 per year (Table 1). A sample ID hybrid schedule is shown in Table 2. Overall resident satisfaction with the ID hybrid rotation was 4.7 (std. dev. 0.7) on a 5-point Likert scale. This rotation has consistently been among the highest rated rotations by residents. In-training examination ID scores increased significantly with creation of the Amb ID rotation in 2013 and further increased since 2017 with creation of the ID hybrid, in which both inpatient and ambulatory residents receive the weekly teaching sessions (Figure 1). Pilot educational innovations through this rotation include an online web-based antibiotic stewardship curriculum (2014–2015) and a mobile app-based ID board review platform utilizing spaced interval learning (2018–2019). Conclusion A hybrid inpatient–outpatient ID rotation for IM residents has proven to be a highly effective platform for ID education and curriculum innovation at our institution. This concept could be exported to other institutions and increase IM resident interest and breadth of clinical exposure in ID. Disclosures Ank E. Nijhawan, MD, MPH, Gilead Sciences, Inc.: Research Grant.

scholarly journals Promoting Quality Care for Recently Resettled Populations: Curriculum Development for Internal Medicine Residents

2014 ◽  
Vol 6 (2) ◽  
pp. 310-314 ◽  
Author(s):  
Marina MacNamara ◽  
April Wilhelm ◽  
Geolani Dy ◽  
Sarah Andiman ◽  
Carol Landau ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Focus Groups ◽  
Medical Training ◽  
Quality Care ◽  
Hospital Staff ◽  
Online Information ◽  
Preliminary Assessment ◽  
Internal Medicine Residents ◽  
Adequate Education ◽  
Survey Results

Abstract Background Residents report they lack preparation for caring for an increasingly diverse US population. In response, a variety of curricula have been developed to integrate cultural competency into medical training programs. To date, none of these curricula has specifically addressed members of recently resettled populations. Methods A preliminary assessment was conducted among internal medicine (IM) residents at 1 program (N  =  147). Based on 2 conceptual frameworks and the survey results, a pilot curriculum was developed and integrated into the interns' ambulatory block education within the general IM track (n  =  9). It included (1) online information made available to all hospital staff; (2) 4 interactive didactic sessions; and (3) increased exposure to newly arrived patients. The curriculum was qualitatively evaluated through 2 focus groups. Results The preliminary assessment was completed by 101 of 147 residents (69%), with 61% of respondents indicating they felt that they received less than adequate education in this area. Eight of the 9 interns exposed to the new curriculum participated in the focus groups. Overall, respondents reported they thought patient care had improved for recently resettled populations and across their patient panels after exposure to the curriculum. Conclusions This study demonstrated that an intervention that included didactics and enhanced exposure to a diverse population improved IM interns' perceptions of care for all patients, including recently settled individuals.

scholarly journals Improving the Communication Skills of Internal Medicine Residents Using Family Meeting Simulation Exercises in the Medical ICU

CHEST Journal ◽  
2016 ◽  
Vol 150 (4) ◽  
pp. 602A
Author(s):  
Travis Watai ◽  
Brent Matsuda ◽  
Gehan Devendra ◽  
Cody Takenaka ◽  
Kamal Masaki ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Communication Skills ◽  
Family Meeting ◽  
Internal Medicine Residents ◽  
Simulation Exercises

scholarly journals Resident Scores on a Patient Satisfaction Survey: Evidence for Maintenance of Communication Skills Throughout Residency

2011 ◽  
Vol 3 (4) ◽  
pp. 487-489 ◽  
Author(s):  
Emily A. Stewart ◽  
Dina Halegoua-De Marzio ◽  
Douglas E. Guggenheim ◽  
Joanne Gotto ◽  
J. Jon Veloski ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Satisfaction ◽  
Communication Skills ◽  
Satisfaction Survey ◽  
Patient Satisfaction Survey ◽  
Patient Rating ◽  
Internal Medicine Residents ◽  
Significant Difference ◽  
Different Levels ◽  
Satisfaction Surveys

Abstract Objective To examine whether resident communication skills evaluated through patient satisfaction surveys demonstrate evidence of decline through the 3 years of internal medicine residency. Methods Data for this study were collected retrospectively from a database of patient satisfaction surveys completed for internal medicine residents at different levels of training. Patient satisfaction was measured with the Aggregated EVGFP (excellent, very good, good, fair, or poor) questionnaire recommended by the American Board of Internal Medicine. Results Over a span of 5 years (2005–2009), a total of 768 patient rating forms were completed for 67 residents during their 3 years of residency training. In postgraduate year (PGY)–1, the residents had a mean satisfaction rating of 4.33 ± 0.48 compared to a mean rating of 4.37 ± 0.45 in their PGY-3 year. Analysis of variance indicated no significant difference by PGY level. Conclusion Our findings demonstrate that resident communication skills and patient satisfaction do not decline during the 3 years of residency. This is contrary to our hypothesis that patient satisfaction would worsen as residents progressed through training.

scholarly journals Urine Microscopy for Internal Medicine Residents: A Needs Assessment & Implementation of Virtual Teaching Sessions

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0006282020
Author(s):  
Jorge Chancay ◽  
Meghana Eswarappa ◽  
Luis Sanchez Russo ◽  
Matthew A Sparks ◽  
Samira S Farouk
Keyword(s):  
Internal Medicine ◽  
Online Survey ◽  
Video Conferencing ◽  
Urine Sediment ◽  
Clinical Interpretation ◽  
School Of Medicine ◽  
Internal Medicine Residents ◽  
Survey Results ◽  
The Impact ◽  
Urine Microscopy

Background: Though urine microscopy is an important step in the initial evaluation of a patient with kidney disease, internal medicine residents have minimal exposure to this technique during their training. The goal of this study was to understand knowledge of and attitudes towards urine microscopy among internal medicine residents, and to implement virtual urine microscopy teaching sessions. Methods: A voluntary, anonymous, online survey was sent to all the categorical internal medicine residents training (n = 131) at the Icahn School of Medicine at Mount Sinai (ISMMS). The survey included thirteen questions to assess attitudes towards, experience with, and clinical interpretation of urine microscopy specimens. In response to the survey results, we implemented virtual urine microscopy teaching sessions using video conferencing software which incorporated real-time urine sediment analysis with nephrology fellows and attending nephrologists. Results: The survey response rate was 45% (59/131). Forty-seven percent (28/59) of respondents reported performing urine microscopy at least once during their training and 75% (44/59) of respondents did not feel comfortable performing urine microscopy. The majority of residents (92%, 54/59) reported they felt urine microscopy was very helpful or somewhat helpful in the evaluation of patients with AKI. Overall, 41% percent of responses to clinical interpretation questions were considered correct. Following survey completion, virtual urine microscopy sessions were held monthly and well received by the participants. Conclusions: Our study found that internal medicine residents perceive urine microscopy as a helpful diagnostic tool, though lack the skills to perform and interpret urine microscopy sediments. Virtual educational sessions using video conferencing software are a technically feasible approach to teaching urine microscopy to internal medicine residents. Future studies include a study of the impact of these sessions on learning of urine microscopy.

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