An Advanced Communication Skills Workshop Using Standardized Patients for Senior Medical Students

• DOI: 10.15766/mep_2374-8265.11163
• Publication Date: 2021-05-27T04:00:12Z
• Authors: Jaideep S. Talwalkar; Auguste H. Fortin; Laura J. Morrison; Alan Kliger; David I. Rosenthal; Tanya Murtha; Matthew S. Ellman
• Keywords: Medicine (General); Students, Medical; Standardized Patient; Communication; 4. Education; Original Publication; Clinical Skills Assessment/OSCEs; Strong Emotion; Internship and Residency; Communication Skills; L; Education; Feedback; 3. Good health; 03 medical and health sciences; R5-920; 0302 clinical medicine; Goals of Care; Humans; Peer-Assisted Learning; Education, Medical, Undergraduate

OPEN ACCESSMay 27, 2021An Advanced Communication Skills Workshop Using Standardized Patients for Senior Medical Students Jaideep S. Talwalkar, MD, Auguste H. Fortin, MPH, Laura J. Morrison, Alan Kliger, David I. Rosenthal, Tanya Murtha, Matthew Ellman, MD https://orcid.org/0000-0003-2471-8159 Associate Professor, Departments of Medicine and Pediatrics, Director Clinical Skills, Yale School E-mail Address: [email protected] , MPH Department Medicine, Education, Hospice Palliative Fellowship, Assistant Capstone Course, Pediatrics (Critical Care Medicine), Columbia University Student End-of-Life https://doi.org/10.15766/mep_2374-8265.11163 SectionsAboutPDF ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: students often lack training in advanced communication skills encompassing emotionally fraught situations those which an intense emotional response is expected. Such are required clinical encountered during residency. We created evaluated workshop (ACSW) using standardized patients senior medical students. The emphasized four scenarios—strong emotion, goals care, error, palliative care assessment—and utilized formative peer assessment feedback. Methods: the ACSW cases with case-specific behavior checklists a common modified Master Interview Rating Scale Course In groups three, rotated through three stations. Each student conducted one interviews while other two completed provided verbal performed one-way analyses variance on Likert responses content analysis open post-ACSW survey. Results: Ninety-one assigned high value to all roles: interviewer, observer, feedback recipient, provider. rated experience above average excellent nearly survey items. Open-response themes included "liked opportunity give or receive feedback" (46%) "found helpful" (45%). Discussion: Feasible well received by students, our offers practice observe A peer-assisted, learning model, efficiently addresses key aspect residency preparation. Educational Objectives By end this activity, learners will be able to: 1.Practice strategies managing difficult encounters who display strong emotions.2.Discuss resuscitation preferences family member critically ill patient.3.Demonstrate model disclosing error patient.4.Take history patient no remaining curative treatment options.5.Deliver checklist-driven after observing encounter.6.Receive from peers communicating under specific circumstances. Introduction acquisition skills, essential elements doctoring that bring throughout their careers, core training.1 families fundamental skill,2 used as certifying licensing boards measures physician competence.3,4 Observed structured examinations (OSCEs) (SPs) widely both teach assess basic school.5–7 However, when these become residents, they expected manage requiring more skills,1 clinicians must navigate circumstances can expected.8 During school, rarely have lead conversations skills. This has led some educators develop OSCEs1 show how might interact real patient.9 Descriptions such OSCEs focused important competencies motivational interviewing,10,11 delivering serious news,10,12 circumstances.13,14 More address targeted postgraduate trainees (i.e., fellows) topics disclosure,15,16 care,15 specialty-specific content.16–18 none pure peer-feedback number breadth descriptions still limited compared content.5 training, residents direct observation related skills.19 despite longstanding recognition emphasis ongoing maturation clinician at bedside.20 Given amount time spend together, formal mechanisms been incorporated into training.21,22 For most useful, deliberate instruction giving receiving valuable.23 Prior 2017, curriculum (MS4s) school contained didactic role-play exercises but only single OSCE station assessment.24 success existing station, we sought expand developing multistation SPs emotion (anger), assessment. previously demonstrated MS4s was concordant done faculty.8 Here, describe development evaluate satisfaction ACSW, specifically student-only had enhance Unlike published solely relies Methods Curricular Context built held prior graduation institution. 3-week reflected knowledge acquired learned additional would Through lectures workshops, discussed high-yield especially relevant (e.g., interpretation electrocardiograms, anaphylaxis management, wellness practices, personal finance). All activities course were ungraded. Earlier curriculum, patient-centered interviewing, news, problem-focused visits). There As part multiyear redesign entire revised, providing novel teaching strategies. described here took place first year revised 2017. Pilot Phase 2016, convened 10-person working group consisting members Instruction team, Patient Program, Teaching Learning Center,25 team. reviewed elsewhere goal OSCE. considered possible models: faculty, assessment, SPs. presented models unenthusiastic about faculty challenging new so close felt SP received. stations also resource intensive, piloted utilizing checklist designed station.24 recruited six volunteers not case single-station pilot May 2016. Two extensive trained script participated. brief overview session logistics told provide behavior-based relying checklist. each trio, 20-minute interview B C observed Upon completion interview, gave checklist-based A. Faculty live video streams sessions, recorded. exercise, debriefed SP. debriefing pilot, universally reported finding valuable. interviewed appreciated higher-level skill found classmates helpful. classmate's performance itself. exercise seriously out importance being addressed reality internship horizon. One said, "I'd rather now than do it intern Emergency Department." commented preferred having room made them less self-conscious feedback: "If expert room, I wouldn't feel like anything useful add." Overall enthusiastic prospect broader scale, covering topics. mirrored closely what he said. He impressed depth accuracy Similarly, quality interviewers, constructive, specific, actionable. Case Checklist Design adopted peer-assessment developed final list scenarios ACSW: invited experts area design preliminary underwent multiple rounds revision between group, (CBCs). (Jaideep Talwalkar Ellman) independently ranked 28-items (MIRS) based applicability redundancy items CBCs. MIRS instrument measuring skills.26,27 After reconciling rank lists reviewing selections nine-item (mMIRS) use across process, ensure consistency style format 12 Program participate OSCE, cases. studied then participated separate 2-hour case. Training sessions run plus expert. details case, context, practiced playing roles. CBC study project; assessments shared concordance assessment.8 Logistics days before presentations demonstrations various Course. These topic scenario among content. feedback, minimize announcements workshop. objectives structure itself, predetermined order randomly (Appendix A). Similar observed. entering background materials, vignette along mMIRS (Appendices B–E). left take break, given 2 minutes complete self-assessment) assessment). facilitated 8-minute next moved stations, rotating roles once twice F). filled anonymous six-item five 5-point scale (1 = Poor, Below Average, 3 4 Above 5 Excellent) open-response prompt G). wave attended 30-minute involved development; debriefing, general H). staff always present guide SPs, answer questions, handle paperwork scripts, checklists), check informally, session. Immediately following session, apart educational innovation, reached email offer if needed. weeks reconvened debrief plan year. $3,000 cost entirely paying wages. figure does include salaried overhead costs facility rooms). Analysis post-OSCE Qualitative performing identify repetitive themes. Text coded themes, frequencies calculated. Statistical Social Science Statistics Microsoft Excel Results 91 ACSW. Completion indicated consent utilize data evaluation, surveys 100% participants. On Likert-scale items, interviewer observer recipient provider sessions. Additionally, valued self-assessment Responses range all-case averages individual (Table 1). Table 1. Average Likert-Scale Items Post-OSCE Survey (n 91)Table 91) Mean scores self-reflection lower cases; difference statistically significant (p .01; see elicited indicating poor experience, standard deviations wider. Comments submitted 69 (76%). Content identified 11 distinct categories nonspecific positive negative comments. each. representative Notably, 32 respondents liked 31 (45%) helpful, eight (12%) self-assess reflect. 2. Themes 69)Table 69) team data, observations, proposed ideas improve simplify future iterations. Observations following: •Students exhibited professional appeared quite seriously.•Students engaged chance reflect experiences clerkship workshop.•Some seemed upset unfair. actors' reactions could heard clearly walls.•Faculty needed sessions.•The stayed schedule.•Some confused flow reminders.•Keeping paper organized full-time job member. Discussion four-station relied Throughout workshop, preparation.1 addition practicing efficient administer suggested way foster terms cost, utilization, curricular time. planning orchestration typical OSCEs,7,28 its complexity, remained neutral expert-rater trim resources added original Since purely formative, high-level assurance extensively raters unnecessary. Instead, put financial towards portray medically complex developed. Previous research rating abilities diminish cognitive demands increase.29 With achieve reliability scenarios,24 determined investment unnecessary meet objectives. study, sufficient different types support low-stakes, ACSW.8 utilization. heavily phase played minimal role Thus, allowed us avoid challenge recruiting faculty. recognized benefits role, dedicated self-reflection. surprised previous work describing peer-assisted learning30,31 behaviorally undergone revision. did because replaced interactive format. While itself 14 hours class hours, creating opportunities small-group downtime. get reduced running concurrent involve chose preworkshop tally spread over directly linked Others wishing adopt similar approach need determine students' needs. generally received, there variability case—in very angry—than comments noted unbalanced intensity, particularly charged. written "be livid respond anger" early regardless beforehand. task interviewing recognize empathy, becoming defensive responding fact-based discussion, preceding When misaligned expectations, parties may emotions including anger dissatisfaction.32 Therefore, critical exploration discomfort help interactions. toll SPs; offered breaks opportunities.7 several limitations evaluation changes second administering lessons implementation. instructions, vignettes, cases, burden program staff. subsequent uploaded material online management system just start school-issued tablets instructions F), checklists. moving away paper, reduce administrative perceived too much little in-class orientation walk-through view anticipate well-received since successfully technology engage curriculum.33 pooled best practices ran Finally, note language go encounter impression patient. Educators prime mindset consider substituting statements vignette. "The easy outset" met challenges delivery outset," "has brought long issues you deal with" concerns address." instituted intensity recorded (with permission students) hone performances learn peers. Regarding asked moderate extent expressed anger. calls livid, coached express volume modulate expressions hope perceive overshadows innovation fourth-year institution well-established Program.7 education, generalizability programs hinge availability portraying instructors train them. activity within ungraded course, limit structures. news telephone death notification. Our valuable, encourage institutions simulation References1. Elder twenty-first century. Med Clin North Am. 2018;102(3):545–558. https://doi.org/10.1016/j.mcna.2017.12.014Medline, Google Scholar2. Fortin AH, Dwamena FC, Frankel RM, Lepisto BL, Smith RC. Smith's Patient-Centered Interviewing: An Evidence-Based Method. 4th ed. 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Copyright Permissions© 2021 et al. open-access publication distributed Creative Commons Attribution license.KeywordsPeer-Assisted LearningStandardized PatientMedical ErrorsEnd Life/Palliative CareClinical Assessment/OSCEsStrong EmotionCommunication SkillsGoals CareAcknowledgmentsWe thank Tracie Addy, PhD, Samantha Ahle, Leigh Cromey, John Encandela, Barbara Hildebrand, Anna Reisman, Tracy Yale, helped project.Disclosures None report. Funding/Support Ethical Approval Institutional Review approved PDF DownloadLoading ...