Communication
is an essential component of nephrology care, yet nephrologists receive little
training in communication. We developed a communication workshop for nephrology
fellows, NephroTalk, to address common communication topics encountered
including: giving a diagnosis;
discussing the risks and benefits of treatment options; and addressing
end-of-life decision-making, especially in elderly, medically complex patients.
Our curriculum, modeled after OncoTalk a successful communication skills
program for oncology fellows, was comprised of didactic and practice sessions
with simulated patients and nephrology cases.
The workshop
consisted of one-half day divided into two sessions. Sessions addressed common
communication scenarios in nephrology: delivering bad news and defining goals
of care when the patient is doing poorly. For each session, an overview
presentation highlighted the skills to be practiced including a faculty
demonstration of the skills. After each overview presentation, fellows were
divided into small groups each led by a facilitator for skills practice using
standardized patients. For each practice session, the facilitator followed a
reflective process-oriented framework that focused on identifying the
practicing fellow’s goal and providing the tools to accomplish this goal.
The skills
taught included the following: giving information using Ask-Tell-Ask; recognizing
and responding to emotion using the NURSE acronym; open-ended questions to
elicit care goals and end-of-life preferences; and using “wish” statements to
respond to unrealistic goals.
Twenty-two
fellows participated in the workshop from University of Pittsburgh and Duke
University. We measured perceived preparedness using pre- and post- workshop surveys.
Overall, perceived preparedness following training increased for all
communication challenges including; delivering bad news, expressing empathy,
and discussing dialysis initiation and withdrawal. Fellows rated the course
highly and recommended it to other fellows. Qualitative comments highlighted
how the training would impact future practice: “Listen more intently, limit use
of medical terminology further, give patients more opportunity to express
feelings.”
NephroTalk
is an interactive communication workshop to enhance nephrology fellow
communication skills using didactics and practice sessions to address common
communication tasks in nephrology. From this work, future direction would
involve disseminating our curriculum to other institutions and enhancing the
education of nephrology educators and attendings.
For the a full article on this, check out:
Special post by
Jane Schell MD
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