Surgical Education
Learning by (video) example: a randomized study of communication skills training for end-of-life and error disclosure family care conferences

https://doi.org/10.1016/j.amjsurg.2016.02.023Get rights and content

Highlights

  • We tested an online intervention with general and orthopedic surgery residents.

  • We used reliable instruments to measure end-of-life and error disclosure encounters.

  • All residents improved from pre- to post-test on both encounters.

  • Low scoring residents assigned to treatment outperformed controls on end-of-life.

  • Online resources alone are insufficient.

Abstract

Background

Teaching residents to lead end of life (EOL) and error disclosure (ED) conferences is important.

Methods

We developed and tested an intervention using videotapes of EOL and error disclosure encounters from previous Objective Structured Clinical Exams. Residents (n = 72) from general and orthopedic surgery programs at 2 sites were enrolled. Using a prospective, pre-post, block group design with stratified randomization, we hypothesized the treatment group would outperform the control on EOL and ED cases. We also hypothesized that online course usage would correlate positively with post-test scores.

Results

All residents improved (pre-post). At the group level, treatment effects were insignificant, and post-test performance was unrelated to course usage. At the subgroup level for EOL, low performers assigned to treatment scored higher than controls at post-test; and within the treatment group, post graduate year 3 residents outperformed post graduate year ​1 residents.

Conclusions

To be effective, online curricula illustrating communication behaviors need face-to-face interaction, individual role play with feedback and discussion.

Section snippets

Methods

In the fall of 2014, all categorical PGY1 and PGY3 residents (n = 72) in general and orthopedic surgery programs at the University of Minnesota (UMN) and Mayo Graduate School (Mayo) were enrolled in the study. This included 28 UMN residents (n = 12 general surgery, n = 16 orthopedic) and 44 Mayo residents (n = 20 general surgery, n = 24 orthopedic). All 4 program directors required these residents to take the Family Conference OSCE as part of their annual ACGME Milestone evaluations. They also

Results

Pretest OSCE scores were obtained from 70 of the 72 potential subjects. Paired pre-post OSCE performance scores were obtained for 54 of 70 subjects (see Table 1). Attrition in the sample was due to residents leaving the program (n = 2), excused absences from the post-test (n = 5), and missing data (n = 9). Most of the attrition occurred at 1 site (Mayo), and within 1 specialty (orthopedics), largely due to technical difficulties with B-Line unfortunately occurring on the day many of the

Comments

The ACGME requirement to teach and assess professional interpersonal communication core competencies presents significant challenges to surgery departments, given duty-hour restrictions, compressed curriculum time (accompanied by medical knowledge explosion), and increased clinical demands. At our institutions, there were just no “extra hours” for resident education.

Perhaps sensing these constraints, 1 research team working with practicing oncologists tried an independent learning with feedback

Conclusions

The reality of enhancing professionalism, interpersonal, and communication skills remains daunting for many surgery departments. In this article, we report the results of a labor-intensive study in which a hybrid (online, F2F) intervention was created and rigorously tested with general surgery and orthopedic surgery residents at 4 training programs. Our primary “lesson learned” was that online interventions—even ones that are short and highly visual—are limited if their usage relies primarily

Acknowledgments

The authors are indebted to Ken Yoshida, PhD, for viewing hundreds of hours of videotapes and excerpting examples; and to the UMN AHC Simulation Center staff (Anne Woll, Doug Lakes, Joseph Miller, Alison Von Achen), and the Mayo Simulation Center staff (Denise Foy, Thomas Belda), for implementing the OSCEs. They also thank Maura Sullivan, PhD, for reading a draft of the article. This study was supported in part from a grant from the Association of Surgical Education and the Association of

References (19)

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There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.

The authors declare no conflicts of interest.

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