Download Outline

Seminar 1: Advanced Communication Skills for Surgical Practice
Goals: Residents will be presented with an approach to maximize the effectiveness of
their clinical communication skills.
Objectives: By the end of this session, the resident will understand:
Cognitive Objective
1. Know the three functions of the medical interview and some of the tasks within
each function.
Data Gathering
Relationship Building
Patient Education/Information Giving
2. Know the relevant ethical constructs underlying informed consent.
3. Know what to do when you don’t know what to say
Skills Objective
1. Be able to critique a videotaped interview of a surgery resident obtaining
informed consent for an emergency appendectomy using the three function
model.
2. Demonstrate the ability to conduct an ethically adequate informed consent
conversation.
3. Demonstrate addressing emotional concerns using PEARLS statements
(Partnership, Empathy, Apology, Respect, Legitimization, Support)
SPICE
Session Outline
1.
Curriculum overview
2.
Group Discussion
a. Report cards from the OSCE
3.
Brainstorm
a. The most challenging surgical communication tasks
4.
Mini-lecture
a. Communication principles
5.
Videotape Review Using Checklist
a. Talking to family members about end-of-life decisions
6.
Practice
a. Emotion handling related to health proxy issues
7.
Take home points
SPICE
Relevant Literature
Ambady, N., D. Laplante, et al. (2002). "Surgeons' tone of voice: a clue to malpractice
history." Surgery 132(1): 5-9.
CONCLUSIONS: Surgeons' tone of voice in routine visits is associated with
malpractice claims history. This is the first study to show clear associations
between communication and malpractice in surgeons. Specific types of affect
associated with claims can be judged from brief audio clips, suggesting that this
method might be useful in training surgeons.
Baldwin, P. J., A. M. Paisley, et al. (1999). "Consultant surgeons' opinion of the skills
required of basic surgical trainees." Br J Surg 86(8): 1078-82.
CONCLUSION: This study has identified the skills considered necessary by
consultant surgeons for a successful surgical career. Contrary to expectation,
surgeons value many generic skills more highly than technical skills, indicating
that they value well rounded doctors, not just those with technical ability. The
characteristics identified are being used to develop an assessment tool for use on
basic surgical trainees.
Levinson, W., R. Gorawara-Bhat, et al. (2000). "A study of patient clues and physician
responses in primary care and surgical settings." Jama 284(8): 1021-7.
CONCLUSION: This study suggests that physicians in both primary care and
surgery can improve their ability to respond to patient clues even in the context of
their busy clinical practices. JAMA. 2000;284:1021-1027
McLafferty, R. B., R. G. Williams, et al. (2006). "Surgeon communication behaviors that
lead patients to not recommend the surgeon to family members or friends: Analysis and
impact." Surgery 140(4): 616-22; discussion 622-4.
CONCLUSIONS: Extrapolating these results to 1,618 patient visits/surgeon/year,
results in the following number of patients annually who do not recommend their
surgeons: 15 for failure to adequately explain their medical condition, 15 for
failure to show interest in them, 11 for failure to ask if the patient had questions,
and 10 for failure to answer questions. Considering the ripple effect due to the
number of a patient's FMoFs, surgeons should be aware of the significant impact
of even occasional lapses in optimal communication behaviors.
Sise, M. J., C. B. Sise, et al. (2006). "Surgeons' attitudes about communicating with
patients and their families." Curr Surg 63(3): 213-8.
CONCLUSION: These results suggest that surgical specialists rate themselves as
competent in effective communication, believe in its importance, and agree with
the need for training. An organized approach to training in interaction skills,
especially in giving bad news, is warranted.
SPICE