Resident Training for Successful Professional Interactions.

BACKGROUND: Conflict between healthcare professionals is a common feature of modern healthcare environments, contributing to more stressful working conditions and burnout in frontline staff. In the Royal College of Surgeons in Ireland we undertook to design and deliver a course called 'Professional Interactions' which would equip junior residents in surgery and other acute care specialties with the skills to better manage conflict and bullying. METHODS: The design of this course was based on a Transformative Learning Theory conceptual framework. Key teaching modalities included rational discourse, role-playing, simulations, case studies, reflection exercises and experience with critical incidents and feedback. This experiential learning session was followed with an online short course to reinforce the learning objectives. RESULTS: We in the National Surgical Training Programme have been delivering structured mandatory education to our residents on this topic for over a decade. Each iteration of this programme has been modified based on resident and faculty feedback as well as emerging evidence in the field of communication skills. Recent course evaluation data included feedback from 203 course participants, which represented a 66% response rate. Ninety-two percent of those respondents rated the course as 'Excellent' or 'Good' and that they would use the skills learned 'Daily or 'Weekly'. 85 percent reported a perceived improvement in conflict management skills. CONCLUSIONS: Conflicts and difficult interactions between colleagues in the workplace are a frequent feature of healthcare practice. Teaching residents skills to manage these interactions more successfully may help towards developing a culture of mutual respect in hospital-based practice.

Utilizing Chamber Music to Teach Non-Verbal Communication to Medical Students: A Pilot Initiative.

Introduction The importance of non-verbal cues in communication between physicians and patients is well published in the medical literature. However, few medical school curricula teach non-verbal communication. Chamber musicians employ non-verbal communication to coordinate musician intention. Observation of chamber musicians' use of non-verbal communication may improve the understanding of non-verbal communication among medical students. Methods A total of 72 medical students attended rehearsals of two world-renowned string quartets on a single date. Following a brief discussion and demonstration on non-verbal communication by musicians, students observed the non-verbal cues employed by the quartets during musical rehearsals. Authors provided pre- and post-surveys, which included closed and open-ended questions to assess understanding of non-verbal communication and confidence in identifying non-verbal cues with patients and healthcare providers. Close-ended questions used numerical scales. The authors used paired t-tests to compare mean numerical scores pre- and post-intervention and analyzed qualitative, open-ended responses thematically. Results Of the 72 students who attended the workshop, 63 (88%) completed both pre- and post-surveys. Comparison demonstrated significant improvement in students' ability to appreciate non-verbal interactions among healthcare teams (p<0.05) and patients (p<0.05). Following the workshop, students commented that they appreciated the similarities in non-verbal cues between musicians and medical professionals. Discussion Chamber musicians and physicians share similarities, e.g., working in teams and performing specialized tasks; good communication is crucial to both. Observation of chamber musicians may serve as a vehicle to instruct medical students on non-verbal communication. Next steps include determining the longer-term impact of the workshop on confidence in communication by resurveying participants and comparing responses with those students who did not attend the workshop. Future studies are needed to assess the clinical impact of chamber music observation on medical students' non-verbal communication skills.

Assessing the availability and quality of Spanish-language genetic resources for patients on the internet.

In recent years, people increasingly are accessing health information on the Internet. A significant percentage of the United States (US) population has limited English proficiency with Spanish being the most common other language spoken. There is limited research on the presence or quality of Spanish-language health information, particularly in genetics, on the Internet overall. Therefore, we aimed to assess the availability and quality of patient-specific education resources in Spanish available on US-based support group websites for a wide range of genetic conditions. We assessed 630 websites through the Disease InfoSearch website (www.diseaseinfosearch.org), created by Genetic Alliance, for the presence of Spanish genetic resources for patients with a new diagnosis of a genetic condition. Of these, 261 (41.4%) websites met study criteria for further evaluation. Of the 99 websites (37.9%) that had any Spanish content, 45 Spanish resources and a paired English resource from the same site met criteria for a quality assessment. Scoring was performed by two independent raters using Ensuring Quality Information for Patients (EQIP), a previously validated tool to assess the quality of written health information. The mean scores for Spanish and English resources were 57.3% and 58.4%, respectively, corresponding to a good quality score according to guidelines proposed by authors of EQIP. An independent two-sample t test showed no significant difference in the mean quality scores between Spanish and English resources (p-value = .506). Overall, we found limited availability of Spanish resources on the websites analyzed, but of those identified, there was no difference between the quality of Spanish resources and the paired English resources from the same site. These results highlight the need for genetics professionals to advocate for the creation of more Spanish patient resources. However, genetics professionals can have some reassurance that if a support group does produce a Spanish resource, it likely has comparable quality to its English equivalent.

Comparison of Resident Self-Evaluation to Standardized Patient Evaluators in a Multi-Institutional Objective Structured Clinical Examination: Objectively Measuring Residents' Communication and Counseling Skills.

BACKGROUND: For the past 30 years, there has been a growing emphasis on communication and self-evaluation skills training in graduate medical education. This is reflected in the Next Accreditation System. The Objective Structured Clinical Examination (OSCE) is widely used in graduate medical education for assessing dimensions of interpersonal communication and counseling skills. The OSCEs may be developed to target challenging clinical scenarios difficult to capture in clinical practice and can be used as a medium for resident self-evaluation. OBJECTIVES: The aims of the study were to evaluate residents' interpersonal, communication, and counseling skills using Kalamazoo Essential Elements Communication Checklist in 4 clinically challenging scenarios and to compare standardized patient (SP) evaluations to residents' self-evaluation by category of medical school. METHODS: South East Michigan Center for Medical Education is a consortium of teaching hospitals. Member residents participate in 4 OSCEs as part of their postgraduate 1 curriculum. The OSCEs were developed to evaluate clinically relevant but difficult to capture scenarios including: (a) error disclosure/counseling an angry patient; (b) delivering bad news/end of life; (c) domestic violence; and (d) counseling a patient with colon cancer requesting alternative treatments. At the conclusion of each OSCE, SPs evaluated and residents self-evaluated their performance. Once evaluations were completed, SPs provided residents with feedback. RESULTS: Six member institutions and 344 residents participated during the 2014, 2015, and 2016 academic years. There were more international medical graduates (59%) than graduates of Liaison Committee for Medical Education-accredited medical schools. There were more males (62.2%) than females. Standardized patients rated residents higher than residents rated themselves in 2014 (<0.001), but not in 2015 or 2016. When combining all years and all residents, there was no correlation of SP and resident scores. Standardized patients rated female residents higher than female residents rated themselves (P < 0.0001). Male residents scored themselves similarly to the SPs, but male residents rated themselves higher than female residents rated themselves (P < 0.001). Standardized patient scores for male and female residents were not significantly different. CONCLUSIONS: Targeted OSCEs provide an objective format to evaluate residents in challenging clinical scenarios. Resident self-evaluations did not correlate with SPs. In addition, female residents rated themselves lower than male residents and lower than SPs. There is need to develop interventions and curricula to improve resident's self-evaluation skills and in particular address lower self-evaluation by female trainees.

Disclosure of diagnosis to at-risk relatives by individuals diagnosed with hypertrophic cardiomyopathy (HCM).

Hypertrophic cardiomyopathy (HCM) affects 1 in 200 people and is the most common cause of sudden cardiac death in the young. Given that HCM usually is inherited in an autosomal dominant pattern, an HCM diagnosis has implications for biologically related family members. The purpose of this study was to explore probands' disclosure of an HCM diagnosis with these biologically related, at-risk family members. An online survey was posted on the website of the Hypertrophic Cardiomyopathy Association (HCMA), an advocacy and support group for HCM patients and their families. Descriptive statistics were used to summarize responses to closed-ended questions and demographics. Using an iterative content analysis with the constant comparison approach, we analyzed the responses to open-ended questions inquiring about the nature and role of disclosure communication with at-risk relatives. A total of 315 individuals with a self-reported diagnosis of HCM completed the survey. Most participants (98%) disclosed their diagnosis to at-risk family members. Sixty-four percent disclosed to family members less than 1 year after diagnosis. Participants also disclosed potential treatment options (74.6%) and the emotional impact of the diagnosis (39%). HCM specialists were ranked by participants as being the most helping in explaining the benefit of genetic counseling, while genetic counselor were ranked as least helpful. Emerging themes address the need to encourage screening and genetic testing among family members and to identify external educational resources for use during the disclosure process. Importantly, our study found that the process of disclosure varies based on individuals' experiences and family communication dynamics. However, almost all participants expressed the importance of disclosing the diagnosis of HCM as well as the importance of being screened and expressed needs for additional support during the disclosure process.

Resident Ratings of Communication Skills Using the Kalamazoo Adapted Checklist.

BACKGROUND: The Kalamazoo Essential Elements Communication Checklist-Adapted (KEECC-A) is a well-regarded instrument for evaluating communication and interpersonal skills. To date, little research has been conducted that assesses the accuracy of resident self-ratings of their communication skills. OBJECTIVE: To assess whether residents can accurately self-rate communication skills, using the KEECC-A, during an objective structured clinical examination (OSCE). METHODS: A group of 104 residents from 8 specialties completed a multistation OSCE as part of an institutional communication skills curriculum conducted at a single institution. Standardized patients (SPs) and observers were trained in rating communication skills using the KEECC-A. Standardized patient ratings and resident self-ratings were completed immediately following each OSCE encounter, and trained observers rated archived videotapes of the encounters. RESULTS: Resident self-ratings and SP ratings using the KEECC-A were significantly correlated (r104 = 0.238, P = .02), as were resident self-ratings and observer ratings (r104 = 0.284, P = .004). The correlation between the SP ratings and observer (r104 = 0.378, P = .001) ratings were larger in magnitude, but not significantly different (P > .05) from resident/SP or resident/observer correlations. CONCLUSIONS: The results suggest that residents, with a modicum of training using the KEECC-A, can accurately rate their own communication and interpersonal skills during an OSCE. Using trained observers to rate resident communication skills provides a unique opportunity for evaluating SP and resident self-ratings. Our findings also lend further support for the reliability and validity of the KEECC-A.

Adding new tools to the black bag--introduction of ultrasound into the physical diagnosis course.

INTRODUCTION: Ultrasound, a versatile diagnostic modality that permits real-time visualization at the patient's bedside, can be used as an adjunct in teaching physical diagnosis (PD). AIMS: (1) to study the feasibility of incorporating ultrasound into PD courses and (2) determine whether learners can demonstrate image recognition and acquisition skills. PROGRAM DESCRIPTION: Three hundred seven second-year medical students were introduced to cardiovascular and abdominal ultrasound scanning after training in the physical examination. This consisted of a demonstration of the ultrasound examination, followed by practice on standardized patients (SPs). Pre-post tests were administered to evaluate students' knowledge and understanding of ultrasound. Students performed an ultrasound examination during the PD final examination. PROGRAM EVALUATION: Pre-post test data revealed significant improvements in image recognition. On the final exam, the highest scores (98.4%) were obtained for the internal jugular vein and lowest scores (74.6%) on the Focused Assessment with Sonography for Trauma images. Eighty-nine percent of students' surveyed felt ultrasound was a valuable tool for physicians. DISCUSSION: An introductory ultrasound course is effective in improving medical students' acquisition and recognition of basic cardiovascular and abdominal ultrasound images. This innovative program demonstrates the feasibility of incorporating portable ultrasound as a learning tool during medical school.

Retention of medical genetics knowledge and skills by medical students.

PURPOSE: To determine whether specific knowledge and skills medical students acquire after completing a Year 1 genetics course are retained at the end of Year 3. METHODS: A genetics case was developed for an observed structured clinical exam at the end of Year 3. The case involved a pregnant patient who underwent population screening for cystic fibrosis and is identified as a carrier of a common mutation. Student's performance in completing eight essential genetic tasks taught in Year 1 was assessed by their ability to apply these concepts in the Year 3 observed structured clinical exam. RESULTS: A total of 212 students were included in the study. Performance on the essential tasks revealed that students were better able to discuss inheritance pattern (73.1%). Students were less likely to calculate and discuss fetal risk (25%), discuss the option of prenatal diagnosis if the father is a carrier (25%), and ask about a family history of cystic fibrosis (36.8%). Only half (50%) explained the test result and implications to the patient. There was no correlation between individual student exam scores in Year 1 and the eight essential genetics tasks scores assessed in the observed structured clinical exam (r = 0.003, P < or = 0.67). CONCLUSION: Third year medical students do not retain medical genetics knowledge and skills learned in the first year of medical school. Medical schools need to integrate genetics curriculum through the continuum of the 4 years of medical school.

Combining registry, primary, and secondary data sources to identify the impact of cancer on labor market outcomes.

Some cancers are rapidly becoming chronic conditions that are more and more often diagnosed in working-age individuals. The authors developed a research agenda to study the labor market outcomes attributable to detection and treatment for cancer, and research design and data collection strategies to improve upon other research on these questions. In this article, they describe their approach to combining secondary data sources, primary data collection, and cancer registry data to evaluate the impact cancer has on labor market outcomes such as employment, hours worked, wages, and health insurance. They then critically assess how well their study design and data collection strategy accomplished its objectives. The intention is to offer guidance on how researchers, who are interested in the economic consequences of cancer, as well as of other chronic conditions, might develop and execute studies that examine labor market outcomes. As more attention is placed on the economic aspects of disease, the methods used to estimate productivity loss and other economic outcomes attributable to these conditions require careful scrutiny so that reliable findings can be used to shape health care decisions and policy.

"Once when i was on call...," theory versus reality in training for professionalism.

PURPOSE: To identify the degree to which interns' reported experiences with professional and unprofessional behavior converge and/or diverge with ideal professional behavior proposed by the physician community. METHOD: Interns at Wayne State University's residency programs in internal medicine, family medicine, and transitional medicine responded to essay questions about their experience with professional and unprofessional behavior as part of a curriculum on professionalism. Responses were coded for whether they reflected each of the principles and responsibilities outlined in a major publication on physician professionalism. Content analysis included the frequencies with which the interns' essays reflected each principle or responsibility. Additionally, a thematic analysis revealed themes of professional behavior that emerged from the essays. RESULTS: Interns' experiences with professional and unprofessional behavior most frequently converged with ideal behavior proposed by the physician community in categories involving interpersonal interactions with patients. Interns infrequently reported experiences involving behavior related to systems or sociopolitical issues. CONCLUSIONS: Interns' essays reflect their concern with interpersonal interactions with patients, but they are either less exposed to or less interested in describing behavior regarding systems or sociopolitical issues. This may be due to their stage of training or to the emphasis placed on interpersonal rather than systems or sociopolitical issues during training. The authors recommend future proposals of ideal professional behavior be revised periodically to reflect current experiences of practicing physicians, trainees, other health care providers and patients. Greater educational emphasis should be placed on the systems and sociopolitical environment in which trainees practice.