Explicit Training in Systematic Communication Strategies: A Pilot Study Exploring the Incorporation of Communication Tools by First-Year Residents in Simulation and in Clinical Practice.

OBJECTIVES: Educational approaches for training physicians in clinical communications vary, and whether physicians apply the communication skills they learn or find them useful in the clinic is not well known. The aim of this study was to determine how first-year residents who received explicit instruction in 7 communication strategies would apply them in a simulation exercise and in clinical practice. METHODS: First-year Internal Medicine residents at an urban teaching hospital received instruction in 7 systematic communication strategies: Ask-Tell-Ask, Teach-back, open-ended questioning, NURSE, open body language, pausing, and plain language. Residents were evaluated on their use of specific communication behaviors associated with the 7 strategies during a simulation exercise of disclosing a medical error to a standardized patient. Control group residents who did the simulation before attending the training program and training group residents who did the simulation after the training were compared. Residents were queried 6 months after the training program on their use of communication strategies during clinical practice. RESULTS: A total of 27 residents participated (n = 13 control group; n = 14 training group). The training group performed behaviors for "establishing patient understanding" significantly more often than the control group. Both groups used non-verbal communication and behaviors for addressing patient emotions at similar levels. Of the 24 residents who responded to the 6-month follow-up questionnaire, 24 (100%) reported using Ask-Tell-Ask, open-ended questioning, and Teach-back, and 22 (92%) reported using NURSE statements and non-verbal communication. Most respondents reported using the strategies in clinical practice often or very often (79%) and found the strategies useful or very useful (96%). CONCLUSION: Providing explicit instruction in systematic communication strategies, particularly those focused on establishing patient understanding, may be an efficient approach for helping early career physicians develop effective communication skills that can be readily implemented during clinical training and practice.

Gathering Trainee Feedback to Improve Programs With Low Annual ACGME Survey Content Area Compliance: A Pilot Study.

PROBLEM: Systematically investigating annual Accreditation Council for Graduate Medical Education (ACGME) Resident/Fellow Survey results by directly gathering trainee feedback could uncover training program problems and clarify misunderstandings as they arise, leading to faster corrective actions and program improvement. APPROACH: The Focus Group Forum (FGF) was created based on the utilization-focused evaluation approach to systematically gather comprehensive, high-quality, actionable trainee feedback on specific annual ACGME survey results and involve trainees in program improvement (Henry Ford Hospital, 2021). Trainees from programs with survey results indicating <80% compliance within several content areas were invited to attend FGF sessions. During FGF sessions, neutral moderators experienced in conducting focus groups and creating psychologically safe spaces and neutral scribes gathered trainee feedback on survey results through structured, iterative discussions and an anonymous electronic polling system. Summaries of FGF findings were created, combined with actual annual ACGME survey data, and used to develop recommended corrective actions and monitoring plans. OUTCOMES: In 2021, 6 training programs had survey results below the institution's compliance threshold for 4-8 of the 9 content areas. Of the 180 trainees (from the 6 programs) invited to attend an FGF session, 79 (44%) participated. Five key issues were identified: misinterpretation of several survey questions, lack of knowledge of institutional policies and procedures, perceived inability to share feedback with faculty, feelings of being overwhelmed with administrative duties, and lack of sufficient protected time for educational activities and requirements. NEXT STEPS: The authors are developing an FGF process for faculty so that all stakeholders have a voice regarding annual ACGME survey results. They are also improving scheduling processes so that feedback from experienced trainees who are leaving the institution will not be missed and developing longer-term processes for tracking outcomes since time for implementing corrective actions before the next ACGME survey is limited.

Advice for women considering a career in medicine: A qualitative study of women physicians' perspectives.

BACKGROUND: Research has explored the problems that women encounter during a medical career; however, the advice that experienced women physicians would give to women who have not yet entered the field is needed to reveal how the medical work landscape is evolving and to provide real-world narratives to help career seekers make informed choices. OBJECTIVE: By eliciting women's perspectives on their medical careers by asking them what advice they would give to aspiring women physicians, we aimed to reveal areas for improving career satisfaction of women physicians and to inform those who advise women considering a medical career. METHODS: In this qualitative study, we used a phenomenological approach to conduct semi-structured one-on-one interviews with 24 women physicians to query the advice they would give to women contemplating a career in medicine. RESULTS: Thematic analysis of interview transcriptions revealed 10 themes that women physicians communicated as being important to consider before deciding to become a physician. Although some advice had a cautionary tone, encouraging and practical advice was also conveyed. The most abundant themes concerned the centrality of patient care, a passion for practicing medicine, and the importance of planning. Other key topics included family and friends, self-reflection, life balance, finances, ethics, maintaining presence, and two overt cautionary statements. CONCLUSION: Interviews revealed that meaning and purpose derived from a medical career and maintaining work-life balance are valued by some women physicians. Participants were encouraging in recommending medicine as a career choice for women, while highlighting some challenges.

A Curriculum for Enhancing Physician Teaching Skills: The Value of Physician-Educator Partnerships.

Developing as a physician requires an enormous amount of complex training, and quality of instruction greatly affects training outcomes. But while physicians are expected to teach trainees within the clinic, they often do not receive formal training in effective instructional practices. Providing faculty development programs is one way that institutions can help physicians develop teaching skills, but these programs often are developed without the input of educational specialists and not based in educational theory. In this methodology paper, we describe a 5-module curriculum that was developed in a cross-disciplinary collaboration between instructional designers and physician faculty. By merging educational and medical expertise and using adult learning theory with the Charlotte-Danielson educational framework, an essentials for clinical teaching educational endorsement program (ECTEEP) was created as a feature of the institutional curriculum within a large, urban teaching hospital. Here we describe how the program was developed through a physician-educator partnership, outline the program's key content, and highlight essential aspects of successful implementation. The ECTEEP incorporates active learning approaches within an abbreviated format, distilling 5 critical aspects of effective teaching that are relevant to the clinical environment: cultural humility and safe learning environments, instruction practices for engaging learners, instruction and assessment strategies, receiving and giving feedback, and mentorship and coaching. A central feature of the program is that facilitators actively model the teaching behaviors they are conveying, which underscores the critical importance of facilitator preparation and skill. Our curriculum is offered here as a basic template for institutions that may want to establish a program for enhancing physician teaching skill.

Designing a Yoga Intervention Program to Improve Well-Being for Physician Trainees: Challenges and Lessons Learned.

Well-being activities may help to counteract physician burnout. Yoga is known to enhance well-being, but there are few studies of yoga as an intervention for physicians in training. This prospective methodology-development study aimed to explore how to establish a yoga-based well-being intervention for physician trainees in a large urban training hospital. We aimed to identify factors that contribute to trainee participation and explore an instrument to measure changes in self-reported well-being after yoga. Cohorts included a required-attendance group, a voluntary-attendance group, and an unassigned walk-in yoga group. Weekly 1-hour yoga sessions were led by a qualified yoga instructor for 4 weeks. The seven-question Resident Physician Well-Being Index (RPWBI) was used to measure resident well-being before yoga, after 4 weeks of yoga, and 6 months post-yoga. Trainees attending each session ranged from 17 for required yoga to 0-2 for voluntary yoga, 2-9 for lunchtime walk-in yoga, and 1-7 for evening walk-in yoga. In the required-yoga group (n = 17), overall RPWBI mean scores did not change significantly across the three query times, and participation in the survey declined over time. The mean baseline RPWBI score for the required group before yoga was in the non-distressed range and answers to the seven individual questions varied. Requiring a yoga activity for medical trainees may be a good strategy for promoting participation in yoga. The RPWBI may have limited utility for measuring changes in overall group well-being after a yoga intervention.

Health Care Disparities: a Practical Approach to Teach Residents about Self-Bias and Patient Communication.

Studies have shown that the education of resident physicians on health care disparities (HCDs) needs improvement. We implemented a system-wide program on HCD for residents and evaluated outcomes across 1 year. Designed in 2015 by a multidisciplinary team, the HCD program incorporated information about our health system's patient population and the tenets of unconscious bias. We used the ask-tell-ask model of communication to teach trainees how to identify patients' barriers to health care. In 2016, resident participants in the HCD program were asked to complete a modified version of the Bonham and Sellers RACE survey, which measures consideration of race in clinical care, at four time-points (pre-, post-, 3-months post-, and 1-year post-intervention). Of 186 PGY2 residents who completed the HCD program, 108 (58%) completed all 4 surveys across 1 year. The modified Bonham and Sellers RACE survey yielded a Cronbach's alpha of 0.885 and communality for the six questions ranging from 0.543 to 0.727. Using the modified RACE survey, resident respondents showed overall significantly increased consideration of race in clinical care from pre- to post-intervention time-points (p < 0.001). This study of our program on health care disparities showed that resident survey respondents increased self-reported consideration of race in clinical care after the intervention across 1 year.