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Quality communication improves outcomes across a wide variety of health care metrics. However, communication training in undergraduate medical education remains heterogeneous, with real-life clinical settings notably underutilized. In this perspective, the authors review the current landscape in communication training and propose the development of communication-intensive rotations (CIRs) as a method of integrating communication training into the everyday clinical environment. Despite its importance, communication training is often relegated to a "parallel curriculum." Through integration, CIRs can provide opportunities for reallife skills training, decrease parallel curriculum burden, and provide specialty-specific training in preparation for residency. Clear, efficient communication and human connection remain central in a physician's practice. CIRs reinforce these crucial principles. Potential benefits of a CIR model include role modeling of expert communication techniques; real-time, specific feedback on communication behaviors; development of relationship-centered communication skills and human connection, thereby decreasing burnout; and the opportunity for quality communication practices to become habits in a medical student's daily routine.

Compliance with the Accreditation Council for Graduate Medical Education resident duty hours rules has created unique educational and patient-care challenges for the general medicine inpatient teaching (GMIT) teams at Texas A&M/Scott & White Memorial Hospital, including multiple patient hand-offs, multiple resident absences during teaching time, and loss of continuity of care for individual patients, all of which may have compromised patient safety. The Texas A&M/Scott & White Memorial Hospital internal medicine residency program initially complied with the duty hours rules by having residents take call every fourth night, followed by a six-hour post-call day. This system proved to be inefficient because it significantly disrupted patient care and resident education. Residents reported that this call system frequently caused them to approach the 80-hour limit and that they had difficulty leaving post-call because of unfulfilled responsibilities. They also reported sleep interruption and inadequate time to prepare for and attend educational conferences.After determining the peak admission times at the hospital, program leaders designed a call system during which the primary call team takes admissions from 12:00 pm to 8:00 pm each day, then leaves by 10:00 pm and returns after 10 hours for a full post-call day. After-hours admissions are managed by hospitalists. The solution did require hiring additional hospitalists for night-call coverage. The new structure has greatly improved the residents' experience on the GMIT teams. The entire team works together on call and post-call. Rounds and inpatient teaching continue normally on post-call days. Residents attend clinics and conferences post-call. Hand-offs are reduced greatly, and residents report that they are better rested. Residents also state that the new call system significantly enhances their education, patient care, and personal life.

BackgroundThere has been an increased emphasis over the past decade on quality metrics and competency assessment in healthcare. With the advent of the Next Accreditation System (NAS), assessment is imperative in order to meet ACGME requirements. As the ACGME defined the six physician in training competencies, it became incumbent upon training programs to investigate evaluative measures. Interpersonal and communication competency assessment methods vary among medical educators. Tools such as 360 evaluations, chart audits, patient satisfaction questionnaires, and OSCEs have proven helpful, yet difficult and time-consuming to administer. Ideally, direct observation of trainees would improve the instruction and documentation of communication skills. Clear understanding of the domains of GME Outcomes as well as creation of specific measures that are reliable and accurate while not creating an undue measurement burden are necessary.MethodsInfectious Diseases (ID) physicians rely heavily on communication and interpersonal skills to care for their patients. This multi institutional, qualitative study investigated the approaches used as well as the process employed by ID faculty regarding Interpersonal and Communication skill competency evaluation. Faculty interviews were recorded, transcribed and coded.ResultsBased on the interview transcripts, general themes discovered included a lack of standardization yet considerable value placed upon trainee competency in the areas of interpersonal and communication skills. In addition, ID faculty revealed current practices employed, challenges addressed as well as recommendations for assessment.ConclusionIncrease in accreditation requirements have contributed to additional evaluative responsibilities ID medical educators must adopt. Ascertaining competency assessment methods employed by other ID faculty can provide alternative means of assessment and increase understanding regarding evaluative tools.Disclosures All authors: No reported disclosures.

BackgroundRelationship Centered Communication (RCC) acknowledges the physician’s expertise as well as the patient’s perspective.1 Clinician empathy also serves to improve patients’ ability to cope with chronic diseases.2 Furthermore, effective communication aids with diagnosis and improves treatment adherence.3 Hence, the need to teach and assess competence in Interpersonal Communication - Communicates effectively with patients, caregivers and interprofessional teams milestones. Created in conjunction with the Academy of Communication in Healthcare, RCC training for faculty is encouraged by our organization. Having attended the inter-professional workshop, ID faculty collaborated with the training program to afford the fellows the same opportunity to learn RCC skills.MethodsFaculty have reported limited opportunities to observe/assess their learners. Trainees report infrequent and nonspecific feedback regarding areas for improvement.4 Given these challenges, the ID fellows began a multi-step plan to hone new communication skills after attending the RCC workshop. Activities included both real and simulated encounters as well as didactic presentations. Each scenario built upon the previous one providing continuity of care. Upon completing both outpatient and inpatient encounters, the fellow joined the debriefing team (standardized patient, Program Director and RCC coach) to discuss areas of competence as well as opportunities for improvement. The fellows were also evaluated by faculty in actual patient encounters in addition to choosing a RCC skill to highlight during didactic conference.ResultsActivities provided fellows RCC teaching opportunities, interaction with a standardized patient and learn how the interaction was perceived from the patient’s perspective. Ability to practice in a safe simulation environment, access to coaching and real-time assessment was reported as valuable for all parties. The RCC training afforded both parties the ability to give and receive specific/objective feedback for a competency usually perceived as subjective.ConclusionVaried activities urged the fellows to establish consistent communications habits. The program generated a framework for sustainability of skills and objective assessment.Disclosures All authors: No reported disclosures.