MedEdPORTAL (Dec 2015)
A Curriculum to Enhance Resident Communication Skills During Family Conferences in the Intensive Care Unit
Abstract
Abstract Introduction As part of a hospital-wide initiative to improve patient-physician communication, we developed a curriculum on the facilitation of family conferences in the medical intensive care unit for senior internal medicine residents. The curriculum is designed for integration into day-to-day patient care activities and includes an interactive workshop for teaching communication skills. The goals of this workshop were to review the evidence base for good communication in the intensive care unit (ICU), review effective communication techniques, and familiarize trainees with the modified Common Ground Assessment Instrument (mCGAI) and Feedback Form. Methods The resource includes an instructor's guide for the communication workshop, a PowerPoint slide deck to assist in the facilitation workshop, and copies of the mCGAI and Feedback Form that were used by participants to provide feedback to their peers. Instruction was provided in structured pre− and postconference interdisciplinary team huddles, and via peer feedback through direct observation of actual family conferences. Results Twenty residents participated in the curriculum over a 6-month period. Respondents were assessed before and after the intervention for confidence in facilitation skills, attitudes towards learning skills, and frequency of facilitation. Residents felt that the curriculum was beneficial and helped to develop their family conference facilitation skills. Although trainees felt that family conference facilitation skills were valuable and that experience was a key component of developing facilitation skills, they reported a relatively low frequency of facilitation compared to the opportunities that were available. Despite this, trainees rated their own skills highly both before and after the intervention. In addition, when asked for written comments, participants expressed satisfaction with using the mCGAI as a general template that allowed them to keep multiple skill areas in mind when participating in a conference. Discussion Our findings suggest that internal medicine postgraduate trainees feel that effective facilitation of family conferences is an important skill, that one of the most effective means of learning this skill is through practice, and that further guidance for self-improvement through reflection and performance analysis may be needed. Without formal assessment and actionable feedback, trainees may not be able to develop the skills necessary for performance analysis. A multidisciplinary approach that allows residents to hone their skills with supervision and receive formative feedback from multiple members of the healthcare team may be an effective means of providing this feedback.
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