Objective: Despite the importance of communication skills for neurologists, specific training in this area at the residency level is often lacking. This study aimed to enhance learning of these skills and to encourage reflective practice around communication skills.
Methods:A group of 12 neurology residents participated in a series of six case-based communication skills workshops. Each workshop focused on a particular clinical scenario, including breaking bad news, discussing do-not-resuscitate orders, communicating with "difficult" patients, disclosing medical errors, obtaining informed consent for neurologic tests and procedures, and discussing life-and-death decisions with families of critically ill patients. Residents also kept reflective portfolios in which real examples of these interactions were recorded.
Results:The program was well accepted, and residents rated the workshops as effective and relevant to their practice. Analysis of residents' portfolios revealed three themes relevant to patient-physician communication: 1) communication is more successful when adequate time is allowed, 2) the ability to empathize with patients and their families is essential to successful interactions, and 3) the development of specific approaches to challenging scenarios can facilitate effective interactions. The portfolios also demonstrated that residents would engage in reflective practice. Time and experience alone often fail to produce improvements in physicians' communication skills, 6-8 but there is compelling evidence for a positive effect of communication skills training. 9 Residency programs should therefore develop specific educational interventions that address communication skills.
ConclusionsThe practicing neurologist must be able to rely on a repertoire of communication skills to facilitate effective, patient-centered care. To date, the area of communication skills training has been largely neglected in the neurologic literature. 10 The objectives of this pilot project were to develop a communication skills training program specifically for neurology residents, directed at some of the most challenging clinical scenarios that they will face in practice, and to foster reflective practice as a tool for enhancement of communication skills. Educational intervention. Residents participated in a series of six 2-hour workshops over the course of a single academic year. Each workshop focused on a specific clinical scenario of particular relevance to neurologic practice. Workshop topics were as follows: 1) breaking bad news, 2) discussing do-not-resuscitate orders, 3) communicating with "difficult" patients or family members, 4) obtaining informed consent for neurologic tests, procedures, or therapies, 5) communicating with families around life-and-death decision making for patients with critical illness, and 6) disclosing medical errors. All workshops followed a four-part format. Part 1 was a video clip chosen to trigger discussion on the workshop topic. Part 2 was a facilitated discussion among the reside...