Improving Communication With Surrogate Decision-Makers: A Pilot Initiative

Meltzer, Ellen C.; Shi, Zhenzhen; Suppes, Alexandra; Hersh, Jennifer E.; Orlander, Jay D.; Calhoun, Aaron W.; Tung, Judy; Logio, Lia S.; Manna, Ruth; Bialer, Philip A.; Acres, Cathleen A.; Fins, Joseph J.

doi:10.4300/jgme-d-17-00035.1

Cited by 10 publications

(9 citation statements)

References 27 publications

(44 reference statements)

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“…Table 2 summarizes the 44 single-group, pre–post studies included in the review, 24–67 with 29 studies using a simulated evaluation and 16 using a clinical evaluation (1 study 31 reported on evaluations in both settings). Of the single-group, pre–post studies, 23 used outside observers to evaluate behavior change in a simulated setting, 24–26,28,30,31,33,36–40,42,47,51,54,60,62–67 with 20 reporting significant positive findings of skills change in at least one skill set or domain. Of the 11 studies using SP evaluations to evaluate behavior change in a simulated setting, 26,27,33,34,42,44,47–49,52,54 8 reported significant positive findings in at least one skill set or domain.…”

Section: Resultsmentioning

confidence: 99%

“…Of the single-group, pre-post studies, 23 used outside observers to evaluate behavior change in a simulated setting, [24][25][26]28,30,31,33,[36][37][38][39][40]42,47,51,54,60,[62][63][64][65][66][67] with 20 reporting significant positive findings of skills change in at least one skill set or domain. Of the 11 studies using SP evaluations to evaluate behavior change in a simulated setting, 26,27,33,34,42,44,[47][48][49]52,54 8 reported significant positive findings in at least one skill set or domain. Ten studies used outside observers to evaluate communication in a clinical setting, 29,31,43,45,46,53,56,57,59,61 with 5 reporting significant positive findings in at least one skill set or domain.…”

Section: Single-group Pre-post Studiesmentioning

confidence: 99%

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Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees’ Communication Behaviors: A Systematic Review

Bylund¹,

Vasquez²,

Peterson³

et al. 2022

Academic Medicine

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Purpose A better understanding of how communication skills education impacts trainees’ communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees’ communication behaviors. Method Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. Results Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre–post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. Conclusions This review demonstrates strong support that experiential communication skills education can impact GME trainees’ communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.

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Section: Resultsmentioning

confidence: 99%

Section: Single-group Pre-post Studiesmentioning

confidence: 99%

Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees’ Communication Behaviors: A Systematic Review

Bylund¹,

Vasquez²,

Peterson³

et al. 2022

Academic Medicine

Self Cite

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“…19 Research suggests that EHR-specific empathic communication skills should be taught to practitioners, preferably via experiential learning opportunities, in which learners are observed in a supportive environment and provided direct feedback. 3,16,17,[19][20][21]23,33,34 Given that 46% of participants self-reported prior involvement in education or training on EHR-specific communication skills, this could have biased our results toward the null. An important question remains about whether EHR-specific behaviors truly correlate with better patient experience and, if so, by what means.…”

Section: Discussionmentioning

confidence: 99%

Use of the Electronic Health Record During Clinical Encounters: An Experience Survey

Meltzer

Vorseth²,

Croghan³

et al. 2022

Ann Fam Med

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PURPOSE Use of the electronic health record (EHR) during face-to-face clinical encounters affects communication, and prior research has been inconclusive regarding its effect. This survey study assessed health care practitioner use of EHR-specific communication skills and patient and practitioner experiences and attitudes regarding EHR use during clinical encounters.METHODS For this US-based study, we distributed previously validated surveys to practitioners and adult patients (aged >18 years) at academic primary care practices from July 1, 2018 through August 31, 2018. The electronic practitioner survey was completed first; a paper survey was administered to patients after appointments. Descriptive statistics were calculated, and the Cochran-Armitage test was used to assess for associations between key variables. RESULTSThe practitioner response was 72.9% (43/59); patient response, 45.2% (452/1,000). Practitioners reported maintaining less eye contact (79.1%), listening less carefully (53.5%), focusing less on patients (65.1%), and visits feeling less personal (62.8%). However, patients reported that practitioners provided sufficient eye contact (96.8%) and listened carefully (97.0%); they disagreed that practitioners focused less on them (86.7%) or that visits felt less personal (87.2%). Patients thought EHR use was positive (91.7%); only one-third of practitioners (37.2%) thought that patients would agree with that statement. Practitioners reported stress, burnout, and a lack of sufficient time for EHR documentation.CONCLUSIONS A discrepancy existed in this study between patient and practitioner experiences and attitudes about EHR use, which appeared to negatively affect the experience of health care practitioners but not patients. Organizations should adopt formal strategies to improve practitioner experiences with EHR use.

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“…Examples of OSCE workshops for practicing physicians in the literature are limited. There are few articles that identify the use of OSCEs in training surgical residents and emergency medicine residents, and there are two communication-specific OSCEs among primary care residents [ 7 , 8 , 11 , 17 ]. Among practicing physicians, there are several identified publications that report the use of OSCEs to enhance communication skills [ 10 , 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

A Simulation-Based Workshop to Improve Dermatologists’ Communication Skills: A Pilot for Continuing Medical Education

Saeed

Sanchez

Botto

et al. 2018

Dermatol Ther (Heidelb)

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Introduction Communication skills influence the quality of health care and patient experience; both may affect provider reimbursement. There are few opportunities available for practicing physicians to receive direct feedback on communication in patient encounters. The purpose of this simulation-based patient encounter workshop was for dermatologists to practice and obtain feedback on their communication skills. Methods In March 2016, dermatologists participated in a workshop with four simulated patient encounters. Cases were developed based on a prior needs assessment. Standardized patient educators evaluated participants’ communication using the Master Interview Rating Scale and provided verbal feedback. Physicians rated the usefulness of the simulation and the feedback received through a survey upon workshop completion. Results Of the 170 physicians who registered, 103 participated in the simulation. The workshop was highly rated in meeting its three learning objectives (score of 4.5–4.6 out of a maximum score of 5). The lowest-rated communication skills were as follows: allowing the patient to share their narrative thread (3.1), summarizing the patient’s history from the provider (3.8), and assessing patient understanding (3.8). Conclusions Participants reported that this communication workshop effectively satisfied its learning objectives. Opportunities to practice and improve communication skills as part of continuing medical education will benefit the clinical experience of patients and physicians alike, and the workshop may be formatted to serve physicians of other specialties. The lowest-scoring communication areas identified in this study present an opportunity to develop a tailored curriculum for physician–patient communication in the future.

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Improving Communication With Surrogate Decision-Makers: A Pilot Initiative

Abstract: Residents' communication skills specific to surrogate decision-making benefit from focused interventions. Our pilot assessment of a workshop showed promise, and additionally demonstrated the feasibility of bringing OSCEs and simulated encounters into a busy clinical practice.

Cited by 10 publications

References 27 publications

Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees’ Communication Behaviors: A Systematic Review

Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees’ Communication Behaviors: A Systematic Review

Use of the Electronic Health Record During Clinical Encounters: An Experience Survey

A Simulation-Based Workshop to Improve Dermatologists’ Communication Skills: A Pilot for Continuing Medical Education

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