MedEdPORTAL (Dec 2009)
End-of-Life Communication Education Program for Internal Medicine Residents
Abstract
Abstract Communication skills are critical to the success of every physician; for this reason, the Accreditation Council for Graduate Medical Education lists interpersonal and communication skills as one of the six core competencies. While good communication is important in every physician-patient or physician-family interaction, the consequence of these interactions is magnified in end-of-life situations. Because of a notable absence of training in this area, as well as residents' obvious discomfort in giving bad news, this three-part educational program dedicated to teaching end-of-life communication skills to internal medicine interns was developed. In this series, participants are evaluated on their existing end-of-life communication skills with the use of an OSCE (Objective Structured Clinical Exam), are taught proper techniques in delivering bad news through a 3-hour interactive workshop, and are reevaluated for improvement in their skills, again in OSCE format. Thomas Jefferson University Hospitals (TJUH) data demonstrate a statistically significant increase in internal medicine interns' communication skills based on the 23-point communication checklist used to score both the standardized patient interactions and the clinical vignettes. The interns' checklist scores on the OSCE increased from a mean of 48.1 at baseline to 73.9 for the follow-up assessment. The increase for the scores based on the clinical vignettes was also statistically significant but not as large. Overall, the interns' reactions to the end-of-life communication program have been strikingly positive, which reemphasizes the need for formal education in this specific area of communication skills. Most interns noted that they had never received such training thus far in their medical education and that they did not feel comfortable discussing end-of-life issues with patients and their families. Some specific concerns that interns voiced before the program included worries about choosing the correct words, appropriately showing empathy, and resolving disagreement among family members and patients. After the end-of-life communication program, the interns felt more comfortable discussing end-of-life issues and felt prepared to lead these discussions using the SPIKES Protocol as an outline.
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