Theme: 8AA Communication skills
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A training program for perinatal residents to deliver bad news: feedback from standardized patients can make a difference
Authors: Silvia Setubal
Eliana Amaral		 Institutions: University of Campinas - Obstetrics & Gynecology Department - Campinas - Brazil
 
Background

Summary of Work

IRB Unicamp approval #496.794, Dec 23, 2013 | REBEC #RBR8K3cyk | FAPESP grant #2013/24185-0
Data collection: Jun 2014 to Feb 2015.

Simulation:

  • Y1-Y4 Pediatric & Obstetric residents - Unicamp Medical School, Brazil
  • Cases: Fetal death for OB residents and neonatal near-death for PED.
  • Two well-trained SP played the role of mothers
  • Encounters and feedback were videotaped
  • BBN Skills Checklist & global rating (more details)
  • Usefullness Scale (more details)

SPIKES Training:

Trainer = experienced psychologist (researcher)

  1. Initial discussion about previous experiences on BBN
  2. SPIKES program based on the examples
  3. Discussing residents´ own video from their 1st simulated encounter
  4. Participants evaluated satisfaction with the training program filling a Likert scale
  5. SPIKES training lasted 1-2 hours
  6. Control group offered BBN SPIKES training at the end

Second Simulation:

  • All residents returned for a second simulation case similar to the first one, with the same SP.
  • SPs blinded to resident´s status on training
  • Same procedures as first simulation
more detail
Summary of Results

Conclusion

There was no significant difference between SPIKES and CONTROL group.

Ratings improved for both groups at second simulation.

Residents found time in their busy schedule to participate.

High returning rate to complete participation shows they wanted training.

Less experienced ones more willing to participate.

High usefulness rate suggests residents want to practice and have feedback.

Take-home Messages
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Background
Summary of Work

Resident usefulness of SP experience with feedback

Category

1
Not at all

2
A little

3
Some

4
Very much

5
A lot

1. How much did today´s activity increase your knowledge of how to communicate bad news in perinatology?

2. How much did today´s activity increase your ability to communicate bad news in perinatology?

3. How much did today´s activity increase your understanding of how to communicate bad news in perinatology?

4. How much did today´s activity increase your comfort in communicating bad news?

5. How much did today´s activity increase your comfort in responding to patient´s emotional reactions?

6. How likely today´s activity change your future practices in communicating bad news?

7. How much today´s activity increase your comfort in consoling a patient to whom you have given bad news about her baby?

8. How much today´s activity increase your communication skills in breaking bad news?

9. Please rate the overall educational value of today´s activity

10. Was the SP activity with feedback a good use of your time?

11. Would you recommend this kind of learning experience to your colleagues?

Simulation: BBN Skills Checklist

The doctor …

Y

N

1. Introduced him/herself

2. Asked what the mother know or understand about the baby illness so far

3. Asked about what and how much detail the mother wants to know

4. Used simple and straightforward language to deliver the diagnostic. (If jargon was used, provides an explanation immediately or explains the diagnostic clearly in response to your saying “What does it mean?”

5. After telling the mother the diagnosis, prognosis or important new information paused at least 3 seconds to allow her to speak or invited her to comment

6. Used the “I” statement to express how s/he felt about conveying the news.

7. Acknowledge, legitimated, and/or explored the mother strong emotions before reassuring or moving

8. Asked if the mother had any questions

9. Elicited the mother´s concerns

10. Offered some kind of comfort or hope

11. Asked about/helped mobilize social support

12. Described a range of time when communicating prognostic allow for exemptions

13. Stablished a concreteplan for immediate next steps

14. Reassured the mother that s/he would support her throughout the baby illnss

15. Before closing the encounter asked if the mother had more questions and verify the situation´s compreension.

16. In a zero to ten scale with 0 being weak and 10 being excelent, how would you grade the resident?

Adapted from the Web Paper “ eLearning to enhance physician patient communication: a pilot test of “doc.com” and “WecEncounter” in teaching bad news delivery” by Daetwyler and all, Medical Teacher, 2010;32:e381
Summary of Results
Conclusion
Take-home Messages
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Title:
A training program for perinatal residents to deliver bad news: feedback from standardized patients can make a difference
Theme:
8AA Communication skills
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http://ieposter.com/eposter/1476/a-training-program-for-perinatal-residents-to-deliver-bad-news-feedback-from-standardized-patients-can-make-a-difference.html
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