Difficult conversations: Improving communication skills and relational abilities in health care*

Meyer, Elaine C.; Sellers, Deborah E.; Browning, David M.; McGuffie, Kimberly; Solomon, Mildred Z.; Truog, Robert D.

doi:10.1097/pcc.0b013e3181a3183a

Cited by 181 publications

(133 citation statements)

References 37 publications

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“…A detailed description of the program pedagogy and evaluation outcomes is described elsewhere. 8,9 During the workshops, the clinical course of a preterm infant, Sylvia Ortiz, and conversations with her family were presented (Appendix 1 is available online). Interdisciplinary participants, usually a physician, nurse, and/or a social worker or a chaplain, volunteered to meet with Sylvia's parents, portrayed by actors.…”

Section: Participantsmentioning

confidence: 99%

Analysis of enacted difficult conversations in neonatal intensive care

et al. 2009

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Objective: To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care.Study Design: Physicians, nurses, social workers, and chaplains (n ¼ 50) who attended the Program to Enhance Relational and Communication Skills, participated in a scenario of a preterm infant with severe complications enacted by actors portraying family members. Twenty-four family meetings were videotaped and analyzed with the Roter Interaction Analysis System (RIAS).Result: Practitioners talked more than actor-family members (70 vs 30%). Physicians provided more biomedical information than psychosocial professionals (P<0.001), and less psychosocial information than nurses, and social workers and chaplains (P<0.05; P<0.001). Social workers and chaplains asked more psychosocial questions than physicians and nurses (MD ¼ P<0.005; RN ¼ P<0.05), focused more on family's opinion and understanding (MD ¼ P<0.01; RN ¼ P<0.001), and more frequently expressed agreement and approval than physicians (P<0.05). No differences were found across disciplines in providing emotional support. Conclusion:Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.

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Section: Participantsmentioning

confidence: 99%

Analysis of enacted difficult conversations in neonatal intensive care

et al. 2009

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“…9,14 Grounded in the theory of relational learning, PERCS emphasizes the creation of a safe learning environment, reflection and self-awareness, and diverse perspectives. 9,14 As with PERCS, conversations were kept improvisational (and therefore more authentic) by minimizing scripting. Prestudy and poststudy designs were used to investigate educational impact.…”

Section: Phase Ii: Curriculum Implementationmentioning

confidence: 99%

“…Prestudy and poststudy designs were used to investigate educational impact. 9,14 Residents on elective rotations were assigned to participate in 1 PACE session per academic year. Nurses attended on a voluntary basis with continuing education credits offered as compensation.…”

Section: Phase Ii: Curriculum Implementationmentioning

confidence: 99%

See 1 more Smart Citation

A Simulation-Based Curriculum To Address Relational Crises in Medicine

Peterson¹,

Porter²,

Calhoun³

2012

Journal of Graduate Medical Education

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Introduction Preparing health care professionals for challenging communication tasks such as delivering bad news to patients and families is an area where a need for improved teaching has been identified. Objectives We developed a simulation-based curriculum to enhance the skills of health care professionals, with an emphasis on the communication of difficult or bad news, which we termed relational crises. Methods Our approach was based on a review of existing simulation-based curricula, with the addition of unique features, including a learner-focused needs assessment to shape curriculum development, use of 360-degree evaluations, and provision of written feedback. Development and implementation of our curriculum occurred in 3 phases. Phase I involved a multidisciplinary needs assessment, creation of a clinical scenario based on needs assessment results, and training of standardized patients. In Phase II we implemented the curriculum with 36 pediatric and internal medicine-pediatrics residents, 20 nurses, and 1 chaplain. Phase III consisted of the provision of written feedback for learners, created from the 360-degree evaluations compiled from participants, observers, faculty, and standardized patients. Results Participants felt the scenarios were realistic (average rating of 4.7 on a 5-point Likert scale) and improved their practice and preparedness for these situations (average rating, 4.75/5 and 4.18/5, respectively). Our curriculum produced a statistically significant change in participants' pre- and postcurriculum self-reported perceptions of skill (2.42/5 vs. 3.23/5, respectively, P < .001) and level of preparedness (2.91/5 vs. 3.72/5, respectively, P < .001). Discussion A simulation-based curriculum using standardized patients, learner-identified needs, 360-degree evaluations, and written feedback demonstrated a statistically significant change in participants' self-perceived skills and preparedness for communicating difficult news in pediatrics.

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“…Yet educational initiatives that help trainees achieve competency are challenging, and they remain the responsibility of local institutions without a standardized implementation model. 7 Existing models of communication curricula at the residency level are varied in philosophy, but generally are categorized by pedagogical approach (skills based 4,8 or humanistic 9,10 ); content (fundamental tasks such as basic patient interviewing 11,12 or advanced encounters such as delivering bad news 10,13 ); and interaction focus (clinician-patient/family most often 8,12,13 or less commonly intraprofessional 14,15 ). Additionally, curricula are distinguished by learning technique (role play, 8,16 standardized patients, [17][18][19] or real-life experiences 12,15 ).…”

Section: Introductionmentioning

confidence: 99%