Who do I think you are? The guessing game ice breaker: Building community.

One of the imperatives in experiential learning is finding the dynamic ice breaker that creates a congenial, collegial atmosphere and segues into a resonant learning experience. No matter the topic or issue to be investigated, the ice breaker signals and ultimately confirms for the learner whether (1) they will be heard and supported by the faculty leads, (2) there is an overarching, relevant purpose to the exercise, (3) they are in a supportive, comfortable environment and (4) they have ultimately made the right choice in choosing the session.

Evaluating an Innovative eLearning Pain Education Interprofessional Resource: A Pre-Post Study.

Objective: The challenges of moving the pain education agenda forward are significant worldwide, and resources, including online, are needed to help educators in curriculum development. Online resources are available but with insufficient evaluation in the context of prelicensure pain education. Therefore, this pre-post study examined the impact of an innovative eLearning model: the Pain Education Interprofessional Resource (PEIR) on usability, pain knowledge, beliefs, and understanding of pain assessment skills including empathy. Methods: Participants were students (N = 96) recruited from seven prelicensure health sciences programs at the University of Toronto. They worked through three multifaceted modules, developed by an interprofessional team, that followed a patient with acute to persistent postsurgical pain up to one year. Module objectives, content, and assessment were based on International Association for the Study of Pain Pain Curricula domains and related pain core competencies. Multimedia interactive components focused on pain mechanisms and key pain care issues. Outcome measures included previously validated tools; data were analyzed in SPSS. Online exercises provided concurrent individual feedback throughout all modules. Results: The completion rate for modules and online assessments was 100%. Overall usability scores (SD) were strong 4.27/5 (0.56). On average, pain knowledge scores increased 20% (P < 0.001). The Pain Assessment Skills Tool was sensitive to differences in student and expert pain assessment evaluation ratings and was useful as a tool to deliver formative feedback while engaged in interactive eLearning about pain assessment. Conclusions: PEIR is an effective eLearning program with high student ratings for educational design and usability that significantly improved pain knowledge and understanding of collaborative care.

A listening skill educational intervention for pediatric rehabilitation clinicians: A mixed-methods pilot study.

OBJECTIVE: To prepare for an RCT by examining the effects of an educational intervention on the listening skills of pediatric rehabilitation clinicians, piloting study procedures, and investigating participants' learning experiences. METHODS: Six experienced clinicians received the intervention, consisting of video simulations and solution-focused coaching regarding personal listening goals. Self- and observer-rated measures of listening skill were completed and qualitative information was gathered in interviews and a member checking session. RESULTS: Significant change on self-reported listening skills was found from pre- to post-test and/or follow-up. The pilot provided useful information to improve the study protocol, including the addition of an initial orientation to listening skills. Participants found the intervention to be a highly valuable and intense learning experience, and reported immediate changes to their clinical and interprofessional practice. CONCLUSION: The educational intervention has the potential to be an effective means to enhance the listening skills of practicing pediatric rehabilitation clinicians.

Standardized patient simulation versus didactic teaching alone for improving residents' communication skills when discussing goals of care and resuscitation: A randomized controlled trial.

BACKGROUND: Communication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care. OBJECTIVE: To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care. DESIGN AND INTERVENTION: Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone. PARTICIPANTS: First-year internal medicine residents. MAIN MEASURES: Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure. KEY RESULTS: We enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop ( p = 0.79). The intervention group showed a significant increase in Consultation and Relational Empathy scores post-workshop compared with pre-workshop (35.0 vs 31.7, respectively; p = 0.048), whereas there was no improvement in Consultation and Relational Empathy scores in the control group (35.6 vs 36.0; p = 0.4). However, when the results were adjusted for baseline differences in Consultation and Relational Empathy scores in a multivariable regression analysis, group assignment was not associated with an improvement in Consultation and Relational Empathy score. Improvement in comfort scores and perception of benefit were not associated with improvements in Consultation and Relational Empathy scores. CONCLUSION: Simulation training may improve communication skill and comfort more than didactic training alone, but there were important confounders in this study and further studies are needed to determine whether simulation is better than didactic training for this purpose.

Developing authentic clinical simulations for effective listening and communication in pediatric rehabilitation service delivery.

PURPOSE: To describe the creation and validation of six simulations concerned with effective listening and interpersonal communication in pediatric rehabilitation. METHODS AND FINDINGS: The simulations involved clinicians from various disciplines, were based on clinical scenarios related to client issues, and reflected core aspects of listening/communication. Each simulation had a key learning objective, thus focusing clinicians on specific listening skills. The article outlines the process used to turn written scenarios into digital video simulations, including steps taken to establish content validity and authenticity, and to establish a series of videos based on the complexity of their learning objectives, given contextual factors and associated macrocognitive processes that influence the ability to listen. A complexity rating scale was developed and used to establish a gradient of easy/simple, intermediate, and hard/complex simulations. CONCLUSIONS: The development process exemplifies an evidence-based, integrated knowledge translation approach to the teaching and learning of listening and communication skills.

Beyond winning: mediation, conflict resolution, and non-rational sources of conflict in the ICU.

A 55-year-old woman with widely metastatic breast cancer was admitted to your intensive care unit (ICU) because of a decreased level of consciousness and respiratory failure. She had documented cerebral and meningeal metastases that were progressing despite chemotherapy and radiotherapy. The admitting physician met with her family and suggested a palliative approach, making them very upset. The family insisted that the team 'do everything' and now they refuse to discuss any change in the plan of treatment. They maintain a constant presence at the bedside, taking notes and questioning everyone who enters the room. They have threatened legal action toward several of the nursing staff, and hospital security has been called twice because of shouting matches between family and staff members. As the physician taking over care for the ICU, you would like to resolve this conflict.

Using standardized family members to teach communication skills and ethical principles to critical care trainees.

OBJECTIVE: We sought to determine the effectiveness of standardized family members for improving communication skills and ethical and legal knowledge of senior intensive care unit trainees. DESIGN: Multimodal evaluation of mixed-methods educational intervention. SETTING: Postgraduate critical care medicine academic program. SUBJECTS: Postgraduate subspecialty critical care medicine trainees. INTERVENTION: Communication workshop featuring a short didactic session and four simulated family meetings using trained professionals as standardized family members. MEASUREMENTS: Ethical and legal knowledge and comfort with communication (before and after the workshop) and communication skill (during the workshop). MAIN RESULTS: Fifty-one postgraduate critical care medicine subspecialty trainees participated in the workshop over a 5-yr period. Ethical and legal knowledge and comfort scores improved significantly among trainees who participated in the workshop. Ninety percent of trainees felt that the workshop had met or exceeded their expectations and would recommend it to other trainees. Ninety-eight percent of trainees felt that the workshop had met the highest priority learning objectives they identified. Communication scores showed a trend towards improvement over the course of the workshop, although the improvements were not significant. Participants reflecting on the workshop >1 yr later overwhelmingly felt that it had prepared them for real communication challenges in training and practice. CONCLUSIONS: This workshop was effective for improving ethical and legal knowledge and comfort with communication among critical care medicine trainees. Participants overwhelmingly felt that it had met their learning needs and that it was an effective teaching tool that had prepared them for real communication challenges in training and practice. It could be used in a variety of contexts to address an often-neglected area of education.

Innovation and design of a web-based pain education interprofessional resource.

INTRODUCTION: The present article describes educational innovation processes and design of a web-based pain interprofessional resource for prelicensure health science students in universities across Canada. Operationalization of educational theory in design coupled with formative evaluation of design are discussed, along with strategies that support collaborative innovation. METHODS: Educational design was driven by content, theory and evaluation. Pain misbeliefs and teaching points along the continuum from acute to persistent pain were identified. Knowledge-building theory, situated learning, reflection and novel designs for cognitive scaffolding were then employed. Design research principles were incorporated to inform iterative and ongoing design. RESULTS: An authentic patient case was constructed, situated in interprofessional complex care to highlight learning objectives related to pre-operative, postoperative and treatment up to one year, for a surgical cancer patient. Pain mechanisms, assessment and management framed content creation. Knowledge building scaffolds were used, which included video simulations, embedded resources, concurrent feedback, practice-based reflective exercises and commentaries. Scaffolds were refined to specifically support knowledge translation. Illustrative commentaries were designed to explicate pain misbeliefs and best practices. Architecture of the resource was mapped; a multimedia, interactive prototype was created. This pain education resource was developed primarily for individual use, with extensions for interprofessional collective discourse. DISCUSSION: Translation of curricular content scripts into representation maps supported the collaborative design process by establishing a common visual language. The web-based prototype will be formatively and summatively evaluated to assess pedagogic design, knowledge-translation scaffolds, pain knowledge gains, relevance, feasibility and fidelity of this educational innovation.

Key challenges in simulated patient programs: an international comparative case study.

BACKGROUND: The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance. METHODS: We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources. RESULTS: Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments. CONCLUSION: This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely.