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Mastery Learning of Clinical Communication Skills

  • Julia H. VermylenEmail author
  • Gordon J. Wood
Chapter
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Part of the Comprehensive Healthcare Simulation book series (CHS)

Abstract

Mastery learning of clinical communication skills is not as well studied as mastery learning of other topics but holds great promise to significantly impact patient and family outcomes, provider well-being, and healthcare resource use. This chapter reviews the current state of evidence for communication skills training in general and mastery learning of communication skills in particular. Unique aspects of mastery learning of communication skills, compared to mastery learning of procedural skills, are highlighted and serve as the foundation for an examination of the key tasks in the design of a mastery learning communication curriculum. Particular attention is paid to creating an assessment tool, choosing a model of deliberate practice, and choosing a model for bringing learners to mastery. The chapter concludes with a consideration of future directions for this relatively new field of mastery learning of clinical communication skills.

Keywords

Breaking bad news Communication Communication assessment Communication skills training Mastery learning Patient-reported outcome measures Standardized patients 

References

  1. 1.
    Majesko A, Hong SY, Weissfeld L, White DB. Identifying family members who may struggle in the role of surrogate decision maker. Crit Care Med. 2012;40(8):2281–6.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Lilly CM, De Meo DL, Sonna LA, et al. An intensive communication intervention for the critically ill. Am J Med. 2000;109(6):469–75.CrossRefGoogle Scholar
  3. 3.
    Hutchison PJ, McLaughlin K, Corbridge T, et al. Dimensions and role-specific mediators of surrogate trust in the ICU. Crit Care Med. 2016;44(12):2208–14.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kirchhoff KT, Song MK, Kehl K. Caring for the family of the critically ill patient. Crit Care Clin. 2004;20(3):453–66. ix-x.Google Scholar
  5. 5.
    Nunez ER, Schenker Y, Joel ID, et al. Acutely bereaved surrogates’ stories about the decision to limit life support in the ICU. Crit Care Med. 2015;43(11):2387–93.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5):469–78.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Wall RJ, Engelberg RA, Gries CJ, Glavan B, Curtis JR. Spiritual care of families in the intensive care unit. Crit Care Med. 2007;35(4):1084–90.CrossRefGoogle Scholar
  8. 8.
    Wall RJ, Curtis JR, Cooke CR, Engelberg RA. Family satisfaction in the ICU: differences between families of survivors and nonsurvivors. Chest. 2007;132(5):1425–33.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Boissy A, Windover AK, Bokar D, et al. Communication skills training for physicians improves patient satisfaction. J Gen Intern Med. 2016;31(7):755–61.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Dowdy MD, Robertson C, Bander JA. A study of proactive ethics consultation for critically and terminally ill patients with extended lengths of stay. Crit Care Med. 1998;26(2):252–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lilly CM, Sonna LA, Haley KJ, Massaro AF. Intensive communication: four-year follow-up from a clinical practice study. Crit Care Med. 2003;31(5 Suppl):S394–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Norton SA, Hogan LA, Holloway RG, et al. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med. 2007;35(6):1530–5.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lamba S, Murphy P, McVicker S, Harris Smith J, Mosenthal AC. Changing end-of-life care practice for liver transplant service patients: structured palliative care intervention in the surgical intensive care unit. J Pain Sympton Manage. 2012;44(4):508–19.CrossRefGoogle Scholar
  14. 14.
    Geer JA, Jacobs JM, El-Jawahri A, et al. Role of patient coping strategies in understanding the effects of early palliative care on quality of life and mood. J Clin Oncol. 2018;36(1):53–60.CrossRefGoogle Scholar
  15. 15.
    Irwin KE, Greer JA, Khatib J, Temel JS, Pirl WF. Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Chronic Resp Dis. 2013;10(1):35–47.CrossRefGoogle Scholar
  16. 16.
    Rubenfeld GD, Curtis JR. End-of-life care in the ICUWG. End-of-life care in the intensive care unit: a research agenda. Crit Care Med. 2001;29(10):2001–6.CrossRefGoogle Scholar
  17. 17.
    Mularski RA, Curtis JR, Billings JA, et al. Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workshop. Crit Care Med. 2006;34(11 Suppl):S404–11.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Nelson JE, Mulkerin CM, Adams LL, Pronovost PJ. Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback. Qual Saf Health Care. 2006;15(4):264–71.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Clarke EB, Curtis JR, Luce JM, et al. Quality indicators for end-of-life care in the intensive care unit. Crit Care Med. 2003;31(9):2255–62.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Nelson JE, Puntillo KA, Pronovost PJ, et al. In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med. 2010;38(3):808–18.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Halpern SD, Becker D, Curtis JR, et al. An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine policy statement: the Choosing Wisely (R) top 5 list in critical care medicine. Am J Respir Crit Care Med. 2014;190(7):818–26.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Tulsky JA, Beach MC, Butow PN, et al. A research agenda for communication between health care professionals and patients living with serious illness. JAMA Intern Med. 2017;177(9):1361–6.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    ACGME Common Program Requirements 2017. Available from https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_2017-07-01.pdf.
  24. 24.
    Barsuk JH, McGaghie WC, Cohen ER, et al. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009;37(10):2697–701.PubMedGoogle Scholar
  25. 25.
    Hebert HD, Butera JN, Castillo J, Mega AE. Are we training our fellows adequately in delivering bad news to patients? A survey of hematology/oncology program directors. J Palliat Med. 2009;12(12):1119–24.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Adler DD, Riba MB, Eggly S. Breaking bad news in the breast imaging setting. Acad Radiol. 2009;16(2):130–5.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Eggly S, Afonso N, Rojas G, et al. An assessment of residents’ competence in the delivery of bad news to patients. Acad Med. 1997;72(5):397–9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Schellenberg KL, Schofield SJ, Fang S, et al. Breaking bad news in amyotrophic lateral sclerosis: the need for medical education. Amyotroph Lateral Scler Frontotemporal Degener. 2014;15(1–2):47–54.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Lamba S, Nagurka R, Offin M, Scott SR. Structured communication: teaching delivery of difficult news with simulated resuscitations in an emergency medicine clerkship. West J Emerg Med. 2015;16(2):344–52.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Buss MK, Lessen DS, Sullivan AM, et al. Hematology/oncology fellows’ training in palliative care: results of a national survey. Cancer. 2011;117(18):4304–11.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Holley JL, Carmody SS, Moss AH, et al. The need for end-of-life care training in nephrology: national survey results of nephrology fellows. Am J Kidney Dis. 2003;42(4):813–20.CrossRefGoogle Scholar
  32. 32.
    Makoul G. Communication Skills Education in Medical School and Beyond. JAMA. 2003;289(1):93.Google Scholar
  33. 33.
    Fryer-Edwards K, Arnold RM, Baile W, et al. Reflective teaching practices: an approach to teaching communication skills in a small-group setting. Acad Med. 2006;81(7):638–44.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Back AL, Arnold RM, Baile WF, et al. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167(5):453–60.CrossRefGoogle Scholar
  35. 35.
    Szmuilowicz E, el-Jawahri A, Chiappetta L, et al. Improving residents’ end-of-life communication skills with a short retreat: a randomized controlled trial. J Palliat Med. 2010;13(4):439–52.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Szmuilowicz E, Neely KJ, Sharma RK, et al. Improving residents’ code status discussion skills: a randomized trial. J Palliat Med. 2012;15(7):768–74.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Wayne DB, Moazed F, Cohen ER, et al. Code status discussion skill retention in internal medicine residents: one-year follow-up. J Palliat Med. 2012;15(12):1325–8.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Chung HO, Oczkowski SJ, Hanvey L, et al. Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis. BMC Med Educ. 2016;16:131.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Moore PM, Rivera Mercado S, Grez Artigues M, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev. 2013; Cd003751.Google Scholar
  40. 40.
    Wood GJAR. What is the evidence that advance care plans change patient outcomes? In: Goldstein NEMR, editor. Evidence-based practice of palliative medicine. Philadelphia: Elsevier Saunders; 2017. p. 270–4.Google Scholar
  41. 41.
    Barth J, Lannen P. Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis. Ann Oncol. 2011;22(5):1030–40.CrossRefGoogle Scholar
  42. 42.
    Schoenthaler A, Kalet A, Nicholson J, Lipkin M Jr. Does improving patient-practitioner communication improve clinical outcomes in patients with cardiovascular diseases? A systematic review of the evidence. Patient Educ Couns. 2014;96(1):3–12.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Uitterhoeve RJ, Bensing JM, Grol RP, et al. The effect of communication skills training on patient outcomes in cancer care: a systematic review of the literature. Eur J Cancer Care. 2010;19(4):442–57.CrossRefGoogle Scholar
  44. 44.
    Tulsky JA, Arnold RM, Alexander SC, et al. Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Ann Intern Med. 2011;155(9):593–601.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Shaw DJ, Davidson JE, Smilde RI, et al. Multidisciplinary team training to enhance family communication in the ICU. Crit Care Med. 2014;42(2):265–71.CrossRefGoogle Scholar
  46. 46.
    Sullivan AM, Rock LK, Gadmer NM, et al. The impact of resident training on communication with families in the intensive care unit: resident and family outcomes. Ann Am Thorac Soc. 2016;13(4):512–21.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Stein T, Frankel RM, Krupat E. Enhancing clinician communication skills in a large healthcare organization: a longitudinal case study. Patient Educ Couns. 2005;58(1):4–12.CrossRefGoogle Scholar
  48. 48.
    Stewart M, Brown JB, Hammerton J, et al. Improving communication between doctors and breast cancer patients. Ann Fam Med. 2007;5(5):387–94.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Orford NR, Milnes S, Simpson N, et al. Effect of communication skills training on outcomes in critically ill patients with life-limiting illness referred for intensive care management: a before-and-after study. BMJ Support Palliat Care. 2019;9(1):e21.CrossRefGoogle Scholar
  50. 50.
    Curtis JR, Back AL, Ford DW, et al. Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. JAMA. 2013;310(21):2271–81.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Bays AM, Engelberg RA, Back AL, et al. Interprofessional communication skills training for serious illness: evaluation of a small-group, simulated patient intervention. J Palliat Med. 2014;17(2):159–66.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Curtis JR, Back AL, Engelberg RA. Training for effective patient communication—reply. JAMA. 2014;311(13):1356–7.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Cohen ER, Barsuk JH, Moazed F, et al. Making July safer: simulation-based mastery learning during intern boot camp. Acad Med. 2013;88(2):233–9.CrossRefGoogle Scholar
  54. 54.
    Sharma RK, Szmuilowicz E, Ogunseitan A, et al. Evaluation of a mastery learning intervention on hospitalists’ code status discussion skills. J Pain Symptom Manage. 2017;53(6):1066–70.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Vermylen JH, Wood GJ, Cohen ER, Barsuk JH, McGaghie WC, Wayne DB. Development of a simulation-based mastery learning curriculum for breaking bad news. J Pain Symptom Manag. 2019;57(3):682–7.CrossRefGoogle Scholar
  56. 56.
    Barsuk JH, Cohen ER, Wayne DB, et al. Developing a simulation-based mastery learning curriculum; lessons from 11 years of advanced cardiac life support. Simul Healthc. 2016;11(1):52–9.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Back AL, Trinidad SB, Hopley EK, et al. What patients value when oncologists give news of cancer recurrence: commentary on specific moments in audio-recorded conversations. Oncologist. 2011;16(3):342–50.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Beckstead J. On measurements and their quality. Paper 4: verbal anchors and the number of response options in rating scales. Int J Nurs Stud [Internet]. 2014;51(5):807–14.CrossRefGoogle Scholar
  59. 59.
    Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(10 Suppl):S70–81.CrossRefGoogle Scholar
  60. 60.
    McGaghie WC, Siddall VJ, Mazmanian PE, Myers J. Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009;135(3 Suppl):62S–8.CrossRefGoogle Scholar
  61. 61.
    Mahmood O, Dagnaes J, Bube S, et al. Nonspecialist raters can provide reliable assessments of procedural skills. J Surg Educ. 2018;75(2):370–6.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    George BC, Teitelbaum EN, DaRosa DA, et al. Duration of faculty training needed to ensure reliable performance ratings. J Surg Educ. 2013;70(6):703–8.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Adler MD, Vozenilek JA, Trainor JL, et al. Comparison of checklist and anchored global rating instruments for performance rating of simulated pediatric emergencies. Simul Healthc. 2011;6(1):18–24.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Eppich W, Nannicelli AP, Seivert NP, et al. A rater training protocol to assess team performance. J Contin Educ Heal Prof. 2015;35(2):83–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Northwestern University Feinberg School of Medicine, Departments of Medicine and Medical EducationChicagoUSA

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