Tools and Strategies for Improving Communication
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This project integrates 3 components that will 1) identify the “voice of the patient” at our institution using actual comments from patient surveys and focus groups; 2) develop and pilot with residents strategies for delivering patient-centered care that incorporates simulated patients; and, 3) design an expanded, intensive workshop on patient-centered care practices integrating the lessons learned from the first two components.
“How do you have the conversation?” A Curriculum for Residents
Modern medicine has expanded the range of possible treatments that can prolong life without necessarily providing a quality of life that may be acceptable to a patient and her family. The kinds of decisions that have to be made are especially difficult when the patient suffers from advanced dementia and cannot communicate for him or herself. These are conversations that should always occur in the setting of advanced dementia and we strive to have these conversations led by the outpatient physician before moments of crisis.
Development and Implementation of a Patient-Centered Discharge Curriculum
Hospital discharge is a complex process for patients, nurses, and physicians. To ensure the safety of patients when they leave the hospital, it is important to discharge patients in a careful, thorough, and patient-centered manner, but reality often does not match this ideal. Incorporating the patient’s perspective and concerns is a key component of a safe discharge, but traditionally this has been overlooked in the busy hospital setting. The Patient-Centered Discharge Curriculum, which was develop and implemented by a multi-disciplinary team at Johns Hopkins Bayview Medical Center, empowers patients to participate more fully with the medical team in their health care.
OB and Family Medicine Resident Education Regarding Intimate Partner Violence (IPV)
Resident education on IPV was achieved through two Brown Bag Lunch Discussions and with the use of Objective Structured Clinical Exercises (OSCE). Residents were able to practice the techniques and strategies taught through video-taped standardized patient encounters. This was followed by a group review of all video sessions emphasizing effective techniques while discouraging ineffective techniques. The Health Care Provider Survey On Intimate Partner Violence was administered to the Residents before and after the Resident Education and was scored using the scoring key. IPV training did demonstrate increased resident knowledge, attitude and behavior regarding patient experiences of IPV.
Communication in Family Meetings: Developing and Assessing a Curriculum for Residents
Effective clinician-family communication is essential in all healthcare settings, but particularly in acute care settings such as the intensive care unit (ICU). Information must be shared clearly so family members can understand the nature of their loved one’s illness, as well as the diagnostic and treatment plans under consideration by the ICU team. Beyond content, there is much more to convey – assurances that the doctor, nurse or social worker is truly listening and responsive, that their understanding goes beyond that of the disease per se and includes empathy for the patient’s and family’s situation and feelings, that the professionals caring for the patient seek to work together and with the family as partners on behalf of the patient’s best interests, and have the requisite competence to do so.
Improving Patient Rounds
The IPR project goal was to initiate patient- and family-centered care (PFCC) rounds in a general medicine unit in an adult-care inpatient setting. The project initially followed and measured the performance of one service team practicing PFCC Rounds on a general internal medicine unit with the aim of studying the impact on patient, family, staff, and doctors-in-training satisfaction; unit costs; residents’ and unit efficiency; quality; and safety.
Integrating Patient-and Family-Centered Care into a Simulation-Based Institutional Curriculum
The Dartmouth-Hitchcock Medical Center Challenge Grant utilized their Patient Safety Training Center to deliver two simulation-based educational modules focused on improving the quality of physician-patient communication. The specific topics addressed by these modules are Sharing Bad News and Informed Patient Choice. Patient Family Advisors will be intimately involved in the development process, delivery and evaluation of each module. The curriculum will be based on the key principles of PFCC and “always events”- observable behaviors that ensure all patient care experiences are firmly grounded in dignity, respect, and information sharing.
Resident Performance from the Patient’s View
The Resident Performance project intended to adapt an existing attendant-based evaluation into a patient-centered prototype tool that is concise, valid and reliable, and that enables patients to accurately assess resident performance on 4/6 ACGME competencies. Performance with regard to ACGME core competencies of residents who receive feedback and coaching using the patient-centered tool was compared to that of those who received attending-only feedback.
Patient-Centered Training of Residents on a Medical Ward:
The patient-centered training project established, integrated patient-centered care teams of project faculty and nursing staff to direct residents on a dedicated patient-centered care ward. Dr. Frankel worked with project faculty, nurse teachers and hospital administration, with a focus on strategies for becoming successful change agents. Success of patient-centered care delivery will be determined by descriptive and patient-specific data.
Emergency Medicine Resident Training in Interprofessional Skills: Evaluating a Needs-Based Curriculum:
With the commitment of NYUSOM-Bellevue Emergency Medicine Residency leadership, we created the Emergency Medicine Professionalism and Communication Training (EMPACT) Project. EMPACT aims to expand on previous work by assessing and improving EM resident competency in communication and professionalism through the development, implementation, and evaluation of new curriculum and assessment measures.
EPOCH: Engineering Patient Oriented Clinic Handoffs
The overall aim of this project is to redesign the end of year handoff process in an internal medicine residency clinic to become more patient-centered by incorporating the patient perspective and their suggestions into this process. To facilitate this redesign, our objectives for this project include: developing an understanding of the ways in which clinic patients perceive the end-of-year handoff process, developing an intervention for internal medicine training that supports a patient-centered end of year handoff, and evaluating the impact of this type of handoff on resident satisfaction, patient satisfaction, and patient outcomes.
Teaching Disclosure: A Patient-Centered Simulation Training for the Crucial Conversation:
The primary aim of this project is to improve residents’ ability to disclose medical errors. Disclosure, the process of bringing to light an unintended outcome, is essential to the nature of the patient-physician relationship. In this project, we are using simulated patient encounters, on-line teaching, self-assessment, and observer assessment to introduce the learners to proper disclosure.
Learning To Talk
This project builds on and enhances the established “Learning to Talk” program at SUNY Upstate Medical University with the addition of the Always Event(s) of “Discharge Guides”. “LTK” is a curriculum of twelve simulation-based training experiences for Upstate residents and fellows in the Department of Medicine to improve physician-patient communication skills.
Improving Transitions of Care for Older Adults through Interdisciplinary Education for Medical Residents
This project proposes to develop an Acute Care for the Elderly Unit Transitional Program (ATP) to teach optimal discharge planning and reinforce interdisciplinary communication through trainee home visits to vulnerable older patients after hospital discharge. The ATP will provide a “living laboratory” to enhance the medical trainees’ understanding of the importance of appropriate discharge planning, communication with the patient, family and caregivers, as well as impact a culturally and socioeconomically diverse population. Additionally, the ATP will meet the stated missions of both the Picker Institute and the Gold Foundation and will provide an innovative educational curriculum for continued measurement of important markers of medical residents’ knowledge, their attitudes regarding both transitions of care and interacting with older adults and their families, and patient outcomes. Successful hospital discharge and transitions of care can be considered Always Events, as all patients experience at least one (and often multiple) care transition following hospitalization.