By Alexander Bolt
As interpersonal communication skills become more important to resident training, institutions are looking to incorporate more of these skills into their curricula. Leading this pack is Henry Ford Health System. The Henry Ford Health Institutional Curriculum has five Objectively Structured Clinical Examinations (OSCEs) that focus on giving first-year medical trainees structured interpersonal communication training.
Henry Ford’s Laurie Rolland, MD, gave a presentation on the innovative curriculum at the IHI National Forum in Orlando in December. The five OSCEs are “Sharing Bad News,” “Informed Consent,” “Error Disclosure,” “Healthcare Disparities,” and “Handoff: Transfer of Care.” They were developed by teams that included residency program directors, inter-specialty physicians, and an instructional designer; they are annually evaluated and modified. Trainees go through the OSCEs with faculty from their individual programs.
The strength of the OSCEs lie in their format, Rolland says, particularly in the utilization of standardized patients: Faculty members facilitate 15-to-20-minute didactic sessions, teaching residents skills and communication tools to use in encounters with standardized patients. The standardized patients are trained to follow detailed “encounter blueprints,” much like actors follow scripts. The encounters simulate scenarios in which a physician would need to demonstrate advanced interpersonal communication skills, such as delivering bad news.
The encounters are videotaped and standardized patients are asked to provide verbal and written evaluations to residents after the session ends. Residents also complete self-assessments. Faculty facilitators review the videotaped sessions with the residents in small groups or one-on-one. Finally, the facilitator issues a written evaluation of the resident’s performance.
This curriculum is designed to be a basic, novice-level training course that teaches fundamental communication skills and tools to residents of all specialties.
For example, during the encounter that simulates sharing bad news, residents use a general, empathetic communication structure, ironically called SPIKES. SPIKES is an acronym for Setting (finding a setting that provides privacy, patient comfort, uninterrupted time), Perception (“What have you been told about your medical condition so far?”), Invitation (“I want to talk about your illness”), Knowledge (Provide information to patients in small bits: “Unfortunately, I have some bad news for you”), Empathize (“I am sure you were not expecting this news”), and Shared decision-making (“Since we have been talking about this situation, let’s look at how you are feeling and the options that are available”).
According to Rolland, most residents are comfortable with this kind of communication, regardless of whether or not they are introverted or extroverted. “Therefore, we have not been able to use this exercise to identify residents who may struggle with communication later in their training,” she said.
“There is a lot interest in this kind of structured curricula,” Rolland told me when I asked if other institutions are adopting a similar curriculum structure. Although a correlation between success on the clinical floor and success in the course has yet to be established, the results from this approach have been good overall:
“We have not yet found correlation between those who do well in the course and those who do well on the clinical floor. However, we have found that verbal feedback from standardized patients can be more discerning than feedback from some facilitators who often succumb to grade inflation, saying, for example, ‘Everyone did great,’” Rolland said. She also noted that, in her experience as a facilitator for the emergency department, there has been noticeable improvement in the average resident’s communication skills over the years – due in large part to increased exposure to standardized patients in medical school.
Going forward, Henry Ford plans to make regular revisions to the current OSCEs and will completely revamp the one entitled, “Handoff: Transfer of Care.” However, no additional OSCEs will be added to the novice-level curriculum. Instead, Henry Ford plans to build off its success by constructing a basic, novice-level interpersonal communication competency and advancing these OSCEs into curricula that is tailored to specific specialties and levels of experience.
Alex Bolt is a staff writer at the Association of American Medical Colleges. He can be reached at firstname.lastname@example.org.