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Chief Complaint - PowerPoint

VIEWS: 12 PAGES: 37

									Missed Opportunities: A Descriptive
    Assessment of Teaching and
Attitudes Regarding Communication
    Skills in a Surgical Residency

            Olivia A. Hutul, B.S.
         Robert O. Carpenter, M.D.
           John L. Tarpley, M.D.
          Kimberly D. Lomis, M.D.

         Vanderbilt University School of Medicine
            Department of General Surgery
          Vanderbilt University Medical Center
                 Nashville, Tennessee
Background

   ACGME general competency:

    “Residents must be able to demonstrate
    interpersonal and communication skills that
    result in effective information exchange and
    teaming with patients, their patients’ families,
    and professional associates.”
Background: Our Goals


   To assess current teaching and evaluation

   To strengthen our residents’ training in
    communication.
Methods

Surveys

   Preliminary needs assessment
   IRB exemption
   Content differed residents v. attendings
   Address several aspects of communication
Surveys

   Value

    Residents and faculty:
     importance of communication skills in the care

      of patients
Surveys

   Frequency

    Residents:
     frequency of PRIMARY responsibility for the

      communication process
Surveys

   Comfort

    Residents and faculty:
     personal comfort with various types of

      conversations

    Faculty:
     comfort with evaluating communication skills
Surveys

   Prior learning experiences
    Residents and faculty:
     familiarity with specific models of communication


    Residents:
     exposure to workshops or other specific forums


    Faculty:
     exposure to specific techniques to teach
      communication
Surveys

   Observation

    Residents and faculty:
     opportunities for the attending to directly observe

      the resident communicating with patients and/or
      families
Surveys

   Feedback

    Residents and faculty:
     frequency of feedback episodes


    Residents:
     helpfulness of feedback


    Faculty:
     limitations to providing feedback
Surveys

   Future learning opportunities

    Residents:
     openness to various learning venues



    Faculty:
     openness to faculty development
Methods

   Voluntary, anonymous surveys

   Samples of convenience composed of:

       Surgical residents at Grand Rounds
       Attending surgeons at a faculty meeting
Results: Demographics
   Survey completed by 49 respondents
         33 surgical residents
         16 attending surgeons


       Residents               Attending surgeons
     (by PGY level)        (by number of years on an
                                academic faculty)
             I:    13
            II:     6             0 to 5 years: 6
            III:    7             6 to10 years: 4
            IV:     6             >10 years: 6
Results: Value

Faculty and residents

   100% of respondents rated importance of
    communication to the successful care of
    patients as “4” or “5”

                           (5 = “very important”)
Results: Value

Faculty:
 “This is as important as operative technical
  skills”
 “Absolutely critical”


Resident:
 “Patients won't let you [operate] unless they
  fully trust you. A good communicator is less
  likely to be sued for malpractice...”
Results: Comfort

Residents

   Residents reported varying levels of comfort
    with different types of conversations
                         Results: Resident Comfort
                                            INFORMED CONSENT
                        25




                        20
NUMBER OF RESPONDENTS




                        15




                        10




                        5




                        0
                             1              2             3          4               5

                                 UNCOMFORTABLE    ------------>   VERY COMFORTABLE
                         Results: Resident Comfort
                                      REPORT OPERATIVE FINDINGS
                        14



                        12
NUMBER OF RESPONDENTS




                        10



                        8



                        6



                        4



                        2



                        0
                             1              2          3            4               5

                                 UNCOMFORTABLE   ------------>   VERY COMFORTABLE
                             Results: Resident Comfort
                                               REPORT BAD NEWS
                        16



                        14
NUMBER OF RESPONDENTS




                        12



                        10



                        8



                        6



                        4



                        2



                        0
                                1              2        3           4               5

                                    UNCOMFORTABLE     ------>    VERY COMFORTABLE
                             Results: Resident Comfort
                                              FAMILY CONFERENCE
                        18


                        16


                        14
NUMBER OF RESPONDENTS




                        12


                        10


                        8


                        6


                        4


                        2


                        0
                                1              2           3          4               5

                                    UNCOMFORTABLE    ---------->   VERY COMFORTABLE
                         Results: Resident Comfort
                                         DISCUSS DNR STATUS
                        16


                        14
NUMBER OF RESPONDENTS




                        12


                        10


                        8


                        6


                        4


                        2


                        0
                             1           2            3               4            5

                                 UNCOMFORTABLE   ----------->   VERY COMFORTABLE
                   Results: Resident Comfort
                                      TRANSITION TO COMFORT CARE
                        16


                        14
NUMBER OF RESPONDENTS




                        12


                        10


                        8


                        6


                        4


                        2


                        0
                             1              2           3         4                5

                                 UNCOMFORTABLE    ---------->   VERY COMFORTABLE
Results: Faculty Comfort

Faculty

   Faculty reported comfort with providing
    feedback specific to communication skills:
        “very comfortable”   56%
        “comfortable”        19%
Results: Observation

Faculty and residents

   Direct attending observation of residents
    communicating with patients and families was
    confirmed by residents and faculty
Results: Feedback
Residents
                                 5 6
                             4
   Episodes of
    feedback in      3
                                       0
    prior 6 months
    reported by          2
    residents
                                  1
Results: Feedback

Faculty and residents

   Discrepancy in reports of feedback episodes:

       16 faculty report total of 67 episodes

       33 resident report total of 24
Results: Feedback

Residents

   30% of resident respondents reported they
    received feedback that was helpful
Results: Learning venues

Residents

   Residents are open to the following:

       clinical setting: 84%
       online resources: 52%
       workshops:        46%
Results: Learning venues

Faculty

   Faculty barriers to teaching (frequency of citation)

       Time constraints:         11
       Lack of vocabulary:       2
       Not a priority:           1
       Trait of physician:       3
Results: Learning venues

Faculty regarding barriers:

   “Should be priority but not given adequate time for
    emphasis it deserves”

   “Need to maintain clinical volume with limited
    support, clinic/OR structure”

   “Clinics are so busy that students, residents, and
    faculty often work in parallel, then faculty come
    behind the trainees to confirm and verify.”
Conclusions


   Communication skills are valued as integral
    to patient care by both residents and faculty
    in this study
Conclusions


   Residents express varying levels of comfort
    with specific communication tasks

   Residents express openness to training
Conclusions

   There is a discrepancy in resident and
    faculty perceptions of feedback
       Only a minority (30%) of residents are receiving
        feedback they perceive as helpful
       Faculty report they are providing feedback to residents

   There is a need to facilitate the feedback
    process to resolve this discrepancy
Limitations


   Small sample size limits interpretation

   Survey measures perceptions, not objective
    quality of feedback
Future Work

Make feedback more intentional

   Standardized instrument
   Based upon accepted model
   Checklist to streamline
   Accessible: web-based
Thank You

								
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