Training to Promote Empathic Communication in Graduate Medical Education: A Shared Learning Intervention in Internal Medicine and General Surgery

Abstract

Background: Empathic communication skills have a growing presence in graduate medical education to empower trainees in serious illness communication. Objective: Evaluate the impact, feasibility, and acceptability of a shared communication training intervention for residents of different specialties. Design: A randomized controlled study of standard education v. our empathic communication skills-building intervention: VitalTalk-powered workshop and formative bedside feedback using a validated observable behavioral checklist. Setting/Subjects: During the 2018–2019 academic year, our intervention was implemented at a large single-academic medical center in the United States involving 149 internal medicine and general surgery residents. Measurements: Impact outcomes included observable communication skills measured in standardized patient encounters (SPEs), and self-reported communication confidence and burnout collected by surveys. Analyses included descriptive and inferential statistics, including independent and paired t tests and multiple regression model to predict post-SPE performance. Results: Of residents randomized to the intervention, 96% ( n = 71/74) completed the VitalTalk-powered workshop and 42% ( n = 30/71) of those residents completed the formative bedside feedback. The intervention demonstrated a 33% increase of observable behaviors ( p < 0.001) with improvement in all eight skill categories, compared with the control who only showed improvement in five. Intervention residents demonstrated improved confidence in performing all elicited communication skills such as express empathy, elicit values, and manage uncertainty ( p < 0.001). Conclusions: Our educational intervention increased residents' confidence and use of essential communication skills. Facilitating a VitalTalk-powered workshop for medical and surgical specialties was feasible and offered a shared learning experience for trainees to benefit from expert palliative care learning outside their field.

Training surgeons to optimize communication and symptom management in patients with life-limiting conditions: systematic review

“…Most interventions were delivered face-to-face in lecture and/or small-group format with facilitators present (33 of 46) 13 , 17 , 20-22 , 24 , 26-30 , 32-36 , 38 , 40-42 , 45 , 46 , 49 , 50 , 52-59 , 61 . The majority of studies employed more than one training approach (for example lectures, small-group discussion, simulation).…”

“…Of the 21 19-23 , 26 , 27 , 30 , 32 , 33 , 39-41 , 43 , 44 , 51 , 53 , 56 , 57 , 58 , 61 studies objectively assessing communication skills (assessed by faculty, simulated patients, or patients), eight 20-23 , 32 , 41 , 44 , 51 studies did not include either a pre-test or comparison/control group for this outcome measure. Four studies used both a control/comparison group and a pre- and post-intervention design 39 , 53 , 57 , 61 . Three of these found that an intensive communication skill training course significantly improved the palliative communication skills of clinicians 53 , 57 , 61 .…”

“…Four studies used both a control/comparison group and a pre- and post-intervention design 39 , 53 , 57 , 61 . Three of these found that an intensive communication skill training course significantly improved the palliative communication skills of clinicians 53 , 57 , 61 . One study compared an intervention group with a comparison group post-intervention, but not to baseline scores—this study found no difference between groups 19 .…”

The State of Palliative Care Education in United States Physical Medicine and Rehabilitation Residency Programs: Heterogeneity and Opportunity for Growth

“…Palliative care educators have steadily developed primary PC communication tools to provide clinicians across specialties concrete approaches to communication with patients. These include the Serious Illness Conversation 28 and Vital Talk program 29,30 ; both can teach PM&R residents clinically relevant skills. Using such frameworks uniformly across residency programs could yield the additional benefit of fostering a shared vision across the PM&R workforce for high-quality patient-centered communication.…”

Curriculum Innovations: Implementing a Neuropalliative Care Curriculum for Neurology Residents

“…Curriculum content was informed by transformative learning theory and validated teaching materials from VitalTalk, 13 which we applied specifically to neuropalliative scenarios in the outpatient clinic, emergency department, and neuro-ICU (Figure). Using transformative learning, we felt it was important not only to teach learners VitalTalk toolsets through didactics but also to supplement this with experiential learning in the form of observed simulated and real patient encounters with feedback.…”