Simulations helped providers understand patient needs during patient communication, emphasizing provider empathy.
You can’t teach empathy, or at least that’s what conventional wisdom suggests. What is often viewed as the crux of good patient-provider communication has long been regarded as one of those intangible elements of provider training, remaining elusive to those who do not “have it.”
But that notion is going away, as medical schools and continuing medical education (CME) programs across the country begin to deploy simulation training helping providers to communicate with their patients better.
A new program out of the Northwestern University Feinberg School of Medicine is just one case of that, with a patient communication simulation program improving qualitative communication scores by about 29 percentage points.
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The simulation program, outlined in a recent article in Academic Medicine, the online journal of the Association of American Medical Colleges (AAMC), specifically looks at how young clinicians break bad news to patients.
“We know patients and families remember these conversations forever,” first author Julia Vermylen, ’11 MD, ’11 MPH, ’14 ’16 GME, assistant professor of Medicine in the Division of Hospital Medicine and of Medical Education, said in a statement. “It’s better to practice these skills in a simulated environment where no one is harmed so that when you do it in real life, people will understand the news, their next steps and know they have a partner in this.”
Vermylen and her team recruited a cohort of 85 fourth-year medical students to take part in Northwestern’s simulation-based mastery learning (SBML) program. The simulations included patient interactions with a live patient actor who would be there to receive bad news that the medical student had to offer.
The study began with a pretest during which the medical students, all of whom reported having broken bad news to patients before, demonstrating their existing knowledge. Students were asked to tell a simulated patient that their headaches were caused by a brain tumor.
The mean score on these pretests was 65 percent.
After completing the training program, which included an assessment of their pretest, feedback from instructors, and group training sessions, medical students took a post test. Scores soared by nearly 29 percentage points, up to 94.2 percent, the researchers reported.
Training centered on reading the emotional cues of patients. When hearing bad news, some patients need more information to gain a sense of control and autonomy over what is likely to be a scary and shocking situation. Others need to express their grief and need the emotional support of their providers.
“The doctor needs to serve all those needs of information, guidance and emotional support,” said Gordon Wood, MD, ’07 GME, associate professor of Medicine in the Division of Hospital Medicine and of Medical Education. “We teach a general framework and set of skills, then use the simulations to practice applying it in different situations.”
This approach runs counter to how communication typically works, Wood added. Typically, providers spend too much time on patient education and not enough time understanding how patients are reacting to the bad news.
“One mistake students often make is they get so focused on the medical information that they forget to recognize the emotional impact of the news on the patient,” Wood explained. “When someone hears bad news, there usually is a flood of emotions and, if the doctor keeps talking about medical information in that moment, patients often report that they didn’t hear anything that was said.”
These simulations are intended to help medical students parse through those complex patient reactions.
“Students need to learn to pause to give the patient a moment to react and they need to gain the skills to help the patient process this new reality,” Wood said. “When this is done well, patients feel supported and the emotional flood recedes enough that they can begin to hear about the medical plan.”
Nobody ever learns or obtains information well when they are in a stressful situation, like learning they have a brain tumor, so information overload is not always useful. Providers should anticipate that they will have to repeat any information they have just communicated at a future date, and remain in the moment and ready to do what is necessary to comfort their patients.
The benefits of this approach go beyond improving the patient experience; they are also essential to improving clinical practice for the provider. Giving bad news is not pleasant for the patient, but is also often emotionally difficult for the clinician.
“Students also reported feeling unprepared for these difficult conversations despite traditional education that included didactics and SP encounters during medical school,” the research team wrote in their study. “Our findings suggest that providing communication skills training with more frequency and within the clinical years as embedded curricula during rotations where the skills are used is needed to best prepare students to enter residency training.”
Source: PatientEngagement HIT