Patient Family Adviser (PFA) Engagement in a Simulated Learning Intervention

to Improve the Quality of Physician-Patient Communication Karen Blum, PFA & Stephen Campbell, PFA

Jonathan Huntington, MD, PhD; Marc Bertrand, MD; Tina Foster, MD, MPH; Ellen Lones, PhD, RN

Aim:

• The DHMC Office Graduate Medical Education, with support

from the Picker Institute Gold Foundation Challenge Grant

program, sought to utilize the Patient Safety Training Center

(PSTC) to develop and deliver a series of education-based

modules intended to improve the quality of physician-patient

communication.

• The principle aim of this project was to engage PFAs as Subject

Matter Experts (SMEs) in the design, delivery and evaluation of

a simulation-based training experience specifically addressing

the challenge of Sharing Bad News.

Project Outline:

• The project directly addressed the ACGME core competencies of Interpersonal & Communication Skills and

Professionalism, areas noted to receive less frequent coverage than the other four competency domains in a recent

institution-wide review of our Regularly Scheduled Conference Series.

• The curriculum was based on the key principles of Patient and Family Centered Care (PFCC) and Always Events® -

observable behaviors that ensure all patient care experiences are firmly grounded in dignity, respect, and information

sharing.

• Intended as a two hour program incorporating the elements noted in the following diagram:

Changes we sought to address:

• An institutionally supported 8,000 square foot PSTC came on-line in 2008 and was not being fully utilized by our 45

Graduate Medical Education (GME) programs.

• As noted above, a recent review of our institutional conferences series identified that communication skills and

professionalism were not addressed in as robust and authentic a fashion as the other four competency domains.

• Simulation is an effective method for learning and practicing interpersonal communication skills as well as various

aspects of professionalism and we saw the opportunity for meaningful involvement of Patient Family Advisors in the

development and delivery of a cross-programmatic, graduate medical education curriculum.

Local issues considered prior to implementation:

• The principle challenge for the team related to time constraints of a busy group of learners (PGY-1 Residents) and

faculty. Scheduling by program-specific groups during their regularly scheduled conference times and limiting the

sessions to 2 hours was found to be the most efficient system.

• Group size was limited to 10 to allow adequate time for the OSCEs and group debrief session while still maintaining

the engagement of the participants and adhering to the two hour time limit.

Project Team:

• PFAs as Subject Matter Experts.

• Resident in combined Internal Medicine/Preventive

Medicine Program.

• Faculty Physicians (Peds, Anes, OB/GYN), Chaplain,

RN-Instructional Design Specialist.

• Initial work in partnership with Henry Ford Hospital.

• Supported by a Picker Institute/Gold Foundation 2010

Challenge Grant.

Sustainability:

• Same intervention delivered to different groups at

different times showed consistent improvement in the

ability to apply the knowledge learned. No data yet

available that it has improved things from the

perspective of the patient.

• The Always Events® framework will remain a

common thread running through all future modules.

• We are committed to supporting a cross-program,

PSTC-based resident curriculum focused on effective

patient communication.

Lessons Learned:

• Match educational program to quality measures

(outcomes).

• Develop specialty-specific scenario scripts to enhance

the learner experience.

• Move to a train-the-trainer mode to attain broader

engagement of program-specific faculty as small

group moderators.

Multiple Measures:

• Pre- and Post- Resident Confidence

Level in Knowledge Application

Across Ten Aspects of

Sharing Bad News

• SP Evaluation of Resident

• Resident Self-Assessment