2012/2013 CHALLENGE GRANTEES

2012/2013 Picker Institute- Gold Foundation
Graduate Medical Education Challenge Grant Program Grantees

Communication Checklist Project

Beth Israel Deaconess Medical Center

Communication Checklist Project

Principal Investigators: Amy Sullivan, EdD & Laura Rock, MD

Overview: In response to a well-documented need at a national level to improve clinician training and practice in communication with patients and families, the BIDMC project team has developed the Communication Checklist Project. This program addresses a need to deliver efficient and effective training that is seamlessly integrated into daily practice. This project aims to validate a communication checklist to objectively measure resident communication competencies in family meetings in the ICU. The impact of resident communication on family outcomes will be measured through interviews and ongoing family satisfaction surveys. This project aims to make the experience of family-centered communication an Always Event for patients and families in the ICU. The long-term goal is to implement this program throughout BIDMC and make it available nationwide.

Using Older Adults’ Experiences of Transitions To Enhance Physician Education

Using Older Adults’ Experiences of Transitions To Enhance Physician Education

Principal Investigator: Renée Shield, PhD

Overview: Problematic transitions plague the experience of older adults in healthcare, and transitions can be dangerous. The imperative to incorporate patient preferences and goals into the reduction and improvement of care transitions is especially compelling for the frailest and most vulnerable adults, who live in assisted living facilities (ALFs) and nursing homes (NHs), experience frequent transitions in sites of care, and are at greatest risk of adverse outcomes. The need is therefore pressing to reinforce patient-centered principles with Internal Medicine (IM) interns at the beginning of their careers. The project team will target IM interns in this proposal since they are the dominant specialty practicing primary care in Rhode Island (RI), with Family Medicine (FM) physicians comprising a distant second group. To deliver successful patient-centered and geriatrics-enhanced medical curricula, the views and experiences of older adults must be core features. In this project, older adults, as well as geriatrician physicians will help develop curricular content and teach these fundamental elements of patient-centered care to IM interns.

Towards Clear and Caring Communication Always

Johns Hopkins Hospital

Towards Clear and Caring Communication Always: Partnering with patients and families to develop and evaluate a simulation-based program for training residents on ‘information sharing’ and ‘caring’ aspects of patient- centered communication

Principal Investigator: Hanan Aboumatar, MD, MPH

Overview: Communication is regularly cited by patients and families as a key area for improvement in healthcare.1 Communication has been identified as a leading root cause in reported sentinel events. Studies have demonstrated that healthcare professionals’ communication skills can be improved and that such improvement is associated with improved outcomes. In this project we will partner with patients to create a brief and sustainable education program that uses simulation, goal setting, and patient feedback to teach residents in two residency programs patient- centered communications skills in the areas of clear information sharing, ensuring patient understanding, and handling difficult conversations . We will study how residents apply the taught skills in their clinical practice and evaluate the project’s impact on the experience of patients receiving ambulatory and hospital care from those residents.

Shared Decision Making in Medication Prescriptions: Improving Communication Skills and Professionalism for Internal Medicine Residents

Shared Decision Making in Medication Prescriptions: Improving Communication Skills and Professionalism for Internal Medicine Residents

Principal Investigator: Leigh Simmons, MD

Co-PI’s: Blair Fosburgh, MD & Karen Sepucha, PhD

Overview: A core component of patient‐centered care is ensuring that patients and families are informed and involved in the decision making process and that they receive treatments that meet their needs and goals. The process of achieving this goal has been termed “shared decision making”. Physicians need to be competent in several different kinds of communication skills in order to implement shared decision making, such effective risk communication (particularly for patients with limited numeracy skills), elicitation of patients’ goals and preferences, and guidance in deliberation and making tradeoffs. These skills are not part of routine medical student education, nor are they formally taught during residency training. The aim of this proposal is to develop and implement an education program for physicians‐in‐training to enhance communication skills and promote shared decision making with their patients in all clinical interactions, with a specific focus on decision making and counseling about medications for chronic conditions. Our proposed initiative will develop and evaluate a new curriculum to promote shared decision making for the initiation of new medications for chronic conditions in the outpatient setting, with a specific focus on the treatment of some of the most commonly‐encountered conditions in outpatient internal medicine: hypertension, type 2 diabetes, hyperlipidemia, atrial fibrillation, and depression.

Always Event: The AlwaysEvent® that the project team has identified is that each time a new medication is prescribed in the outpatient setting for a chronic condition, a shared decision making conversation happens that includes discussion of treatment options, elicitation of patient’s preferences and goals, and the risks and benefits of the treatment prescribed.

Barney Smith: A hospice patient in the emergency department

Barney Smith: A hospice patient in the emergency department

Principal Investigator: Jessica Kalender-Rich, MD

Overview: Medical residents in their first year of training are frequently expected to care for acutely ill patients with very little experience and varying amounts of supervision. Thus, they are also most likely the first physicians to encounter difficult decisions, even about goals of care. Standardized patient (SP) encounters are widely used to teach communication skills. The project team will utilize SPs as an effective tool to teach physical and emotional end-of-life care. It is important for even the newest trainees to have exposure to teaching in communication, family support, and physical comfort. If funded, we will initiate this SP experience with 24 categorical Internal Medicine PGY1 residents. We have chosen this population because despite having the least experience, they are the most likely to be “on-call” at any given time.

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