Background
Anesthesia providers are increasingly recognized for their integral role in perioperative care, where unexpected circumstances may arise at any time; anesthesiologists must be able to effectively and compassionately communicate with families during such times.
While Interpersonal and Communication Skills are ACGME core competencies, they are not sufficiently taught or evaluated in residencies. Aside from short pre-operative interviews on the day of surgery, anesthesia residents have limited opportunities to practice effective communication skills with patients and families. In a pilot survey, residents who completed the Medical ICU (MICU) rotation unanimously responded that a curricular component addressing communications skills would help them lead difficult family conversations. Since residents interact with critically ill patients and their families in the MICU, a required rotation, there are ample opportunities for residents to initiate dialogue and lead family meetings.
The primary goal of this curriculum is for anesthesia residents to acquire communication skills necessary to proficiently lead multidisciplinary meetings in the ICU and apply these skills to leading difficult family conversations throughout the perioperative process.
Methods
Target learners were incoming CA1 anesthesia residents rotating through the MICU. New anesthesiology residents attend daily lectures throughout July. This curricular initiative introduced residents to ICU communications through a patient-interactive session followed by an introductory lecture on communication skills and SPIKES protocol in their orientation month. During the MICU rotation, the critical care faculty present daily high yield topics to residents during morning lectures. The Palliative Medicine faculty was actively involved in this new curriculum and led interactive sessions for residents to practice leading family meetings through role-play and debrief each month. Residents completed pre- and post-rotation assessment surveys, as well as narrative reflections describing standout patient family encounters.
Results
In the pre self-assessment survey administered in July, over 50% of incoming CA1s stated that they felt anxious and only slightly confident when holding difficult discussions with patients. The majority of new anesthesia residents stated that they had not received formal communications training in their medical education.
In the five blocks that we implemented this project, the residents’ post-assessment surveys demonstrated that all felt at least moderately to extremely confident leading family meetings. Over 70% of residents used the newly learned SPIKES protocol at least half the time. As only 2-3 residents rotate through the ICU each block, we have limited data points to date. However, we have received invaluable qualitative comments.
Conclusions
Effective communication between physicians and patients not only improves health outcomes and patient satisfaction, but also reduces error and misunderstandings. Anesthesiologists are expected to communicate effectively with colleagues, patients, and families throughout the perioperative process. However, there is often limited time to formally teach this skill during anesthesiology residency. Throughout this year, we have implemented a new curriculum in the Medical ICU that introduced residents to the SPIKES protocol and techniques to effectively lead family discussions. An overwhelming majority of residents and critical care attendings have enthusiastically supported this curricular addition and advocate for the continuation of this curriculum.
