Resident involvement in postoperative conversations: an underused opportunity

Abstract

Background Because of established attending-patient and family relationships and time constraints, residents are often excluded from the immediate postoperative conversation with family. Interpersonal and communication skills are a core competency, and the postoperative conversation is an opportunity to develop these skills. Our objective is to assess attitudes, experience, and comfort regarding resident participation during postoperative conversations with families. Materials and methods Residents and attending surgeons in an academic surgery center were surveyed regarding resident involvement in the postoperative conversation with families. Paper surveys wereadministeredanonymously.Nonparametricstatisticscomparedresponses. Results There were 45 survey respondents (23 residents, 22 attendings). All residents rated postoperative conversations with families, as “important” or “very important”. Residents reported being “comfortable” or “very comfortable” with postoperative conversations. However, on average, residents reported fewer than 10 postoperative conversation experiences per year. Feedback was received by <30% on postoperative communication skills, but 88% wanted feedback. Most attendings reported it is “important” or “very important” for residents to communicate well with families during postoperative conversations, but rated residents’ performance as significantly lower than the residents’ self-assessments (P < 0.001). Attendings on average were only “somewhat comfortable” or “moderately comfortable” with residents conducting postoperative conversations with families, and only 68% reported allowing residents to do so. When bad news was involved, only 27% allowed resident participation. Most attendings (86%) believed residents need more opportunities with postoperative conversations. Conclusions Although most residents reported being comfortable with postoperative conversations, these survey results indicate that they have few opportunities. Developing a workshop on communication skills focused on the postoperative conversations with families may be beneficial.

Gaps in the Postoperative Conversation: A Comprehensive Review of Current Practices and the Unmet Needs of Surgeons, Families, and Waiting Room Personnel

“…One approach is to collect the preferences and set expectations at the preoperative appointment, considering this is when most of the relationship building occurs. 6 Another possibility is for academic medical centers to reinforce the interpersonal and communication core competency in training residents by including them in perioperative communication practices. This will not only provide necessary skills for the future provider but will also assist in supporting busy attendings by alleviating some of the communication responsibility.…”

“…5 This postoperative stage is particularly critical because at this time providers present relevant operative information and set expectations for follow-up care with caregivers. 6 The perioperative journey is fast paced, involves various characters, and is convoluted with information regarding parking directions, appointment times, procedure policies, surgical progression, the appearance of unforeseen complications, and ultimately the results of the operation. The experience is highly susceptible to communication breakdowns, therefore perioperative communication must be thoroughly understood.…”

“…Residents claim they feel comfortable providing postoperative communication, but admit they have few opportunities to develop the necessary skills. 6 This lack of adequate and standardized training generates variation in communication methods based on the surgeon's personal motivations, beliefs, and previous coaching. These differences sometimes lead to inconsistencies in care, which reinforces the need for a better understanding of the process.…”