2014 UAB RIME Workshop Submission

Title: Put Me In, Coach! Teaching Communication Skills at the Bedside

Objectives:

1.  To explain the SPIKES framework and to list fundamental communication skills in clinical medicine.

2.  To describe the content-focused coaching model and its applicability to bedside communication teaching.

3.  To demonstrate the use of coaching and deliberate debriefing of bedside communication encounters.

Synopsis:

It is estimated that up to 70% of medical lawsuits and more than 20% of hospital complaints stem from poor communication (Wofford MM, et al. Acad Med. 2004; 79:134-8). Conversely, optimal communication has been shown to enhance satisfaction of patients/families and of healthcare providers, to lower burnout among clinicians, and to improve efficiency in the clinical setting (Levetown M. Pediatrics. 2008; 121(5):e1441-60). While many residents want more training in communication skills, particularly in giving bad news (Kolarik R. Pediatrics. 2006; 117(6): 1949-54 and Michelson, KN, et al. J Palliat Med. 2009; 12(5):451-7), residency curricula are often lacking in this regard. Clinical faculty may recognize the need for such training, but often feel unprepared to teach these skills, are pulled toward other competing clinical demands, and worry about an overall lack of time (Perron NJ, et al. Med Teacher. 2009; 31:e316-22).

Nevertheless, fundamental communication skills can be taught and can empower learners to approach difficult communication with patients and families with confidence and compassion. A stepwise approach can break down this complex task into measurable skills (Baile W. Oncologist. 2000; 5:302-11). Various curricula have successfully taught these skills to trainees, but many are not widely implemented due to cost, need for trained standardized patients, and lengthy faculty time commitments (Back AL, et al. Arch Intern Med. 2007; 167(5):453-60 and Boss RD, et al. J Perinatol. 2013; 33(8):642-6).

In this workshop, we will explore a practical method for teaching communication skills at the bedside that is applicable to all clinical faculty. We will review the background of communication training and, using the SPIKES framework for giving bad news, provide specific, measurable communication skills that can be modeled and observed at the bedside. Moving beyond the traditional pedagogical model of “expert” teacher imparting knowledge, we will explore content-focused coaching as a method of deliberate practice that encourages trainee involvement in the learning process, promotes self-reflection, and fosters ongoing refinement of knowledge and skills. We will demonstrate and practice the use of “mini role play” and structured debriefing in bedside communication encounters. We will consider the safe learning environment needed to work alongside our learners in collaboration as we plan, practice, and reflect upon performance.

Agenda:

Topic / Time / Teaching Method
Communication Education Theory / 10 minutes / Didactic/Discussion
SPIKES & Communication Skills / 15 minutes / Didactic/Interactive Exercise
Content-Focused Coaching / 10 minutes / Didactic/Discussion
Coaching & Communication / 30 minutes / Small Group Exercise
Reflection & Questions / 10 minutes / Discussion

Participants: Michael Barnett, MD, MS

Assistant Professor of Medicine & Pediatrics

Program Director, Palliative Medicine Fellowship

Laurel Kilpatrick, MD

Assistant Professor of Medicine

Associate Program Director, Palliative Medicine Fellowship