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Improving the Communication Skills of Internal Medicine Residents Using Family Meeting Simulation Exercises in the Medical ICU FREE TO VIEW

Travis Watai, MD; Brent Matsuda, MD; Gehan Devendra, MD; Cody Takenaka, MD; Kamal Masaki, MD; Reid Ikeda, MD
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John A. Burns School of Medicine, Department of Medicine, Honolulu, HI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):602A. doi:10.1016/j.chest.2016.08.694
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 02:45 PM - 04:15 PM

PURPOSE: Internal Medicine residents rotating through the Medical Intensive Care Unit (MICU) discuss the clinical status and prognosis of critically ill patients during family meetings, often without formal training. The benefits of a formal curriculum focused on enhancing delivery of distressing news to families in the MICU have not been well established. Our objective was to evaluate the impact of a curriculum designed to improve the communication skills and comfort level of Internal Medicine residents conducting family meetings in the MICU.

METHODS: Second and third year Internal Medicine residents rotating through the MICU (n=26) received a 30 minute didactic lecture designed to improve communication during family meetings with content specific to the SPIKES protocol (a six-step method for disclosing unfavorable medical information to patients). Pre and post-lecture Mini-Clinical Evaluation Exercise (Mini-CEX) simulations involving two different enacted scenarios were utilized to evaluate resident interpersonal and communication skills. Two critical care physicians using a modified SPIKES evaluation tool graded each Mini-CEX simultaneously. Residents answered a brief questionnaire to measure the educational value of the overall experience, as well as their comfort level with leading end-of-life discussions before the didactic session and after the post-lecture Mini-CEX.

RESULTS: Mean resident performance significantly improved after the lecture (mean pre-lecture score 24.7 versus mean post-lecture score 46.1 out of a possible 60 points, p<0.001). There was high level of correlation between the Mini-CEX scores of the two MICU attendings (pre-lecture Mini CEX scores correlation coefficient=0.86, p<0.001; post-lecture Mini CEX scores correlation coefficient=0.80, p<0.001). There were no significant differences in scores by gender, post-graduate level, or US graduate versus international medical graduate. The self-assessed comfort level scores of residents delivering bad news showed significant improvement as well (mean pre-lecture score 2.9 versus mean post-lecture score 3.4 on a 1 to 4 scale, p<0.001). This curriculum was very well received, with the majority of residents rating both the lecture and the Mini-CEXs as “very helpful.”

CONCLUSIONS: This study demonstrated that a focused curriculum, including a brief lecture and Mini-CEXs performed with Internal Medicine residents during a Medical Intensive Care Unit rotation, was highly effective in improving the communication skills of residents and their comfort with end-of-life care discussions with family members.

CLINICAL IMPLICATIONS: Establishing rapport and communicating well with family members during difficult clinical situations is essential to delivering high quality patient care. This educational intervention, which can be successfully implemented during a busy critical care rotation, emphasizes the value of a formal curriculum to enhance resident performance and confidence in delivering bad news.

DISCLOSURE: Cody Takenaka: Grant monies (from sources other than industry): Chief Resident Immersion Training (CRIT) - Association of Directors of Geriatric Academic programs in partnership with Boston University/Boston Medical Center with grants from the Hearst Foundation Kamal Masaki: Grant monies (from sources other than industry): Chief Resident Immersion Training (CRIT) - Association of Directors of Geriatric Academic programs in partnership with Boston University/Boston Medical Center with grants from the Hearst Foundation The following authors have nothing to disclose: Travis Watai, Brent Matsuda, Gehan Devendra, Reid Ikeda

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