Simulation for Teaching Communication Skills

  • Jennifer R. Reid
  • Kimberly P. Stone
  • Elaine C. Meyer
Chapter

Abstract

Healthcare communication, consisting of conversations between healthcare providers and with patients and families, is ubiquitous and not always done well. Conveying both factual content and managing the emotional aspect of a conversation takes skill and practice. In this chapter, the components of a healthcare conversation are introduced, as well as several examples of how simulation has been used for healthcare communication training These examples range from the straightforward encounter, the introduction of oneself, to the more complex conversation, such as disclosing a medical error. This can be particularly challenging in pediatrics, where one may have to communicate simultaneously with a child, of varying developmental levels, as well as a parent or multiple family members who are each in their own emotional state. A review of how simulation can be used to prepare providers to communicate with other healthcare providers, specific patient populations, adolescents, family members, and mental health patients is presented, as well as a discussion on how different simulation modalities can be used to create more realistic conversations.

Keywords

Communication Conversations Introductions Difficult conversations Program to enhance relational and communication skills Obtaining a medical history Handoffs Consultation SBAR Informed consent Delivering bad news Disclosing medical errors Confederates Patient actors Adolescents 

References

  1. 1.
    Levetown M. Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics. 2008;121(5):1441–60.CrossRefGoogle Scholar
  2. 2.
    Lipkin M Jr. Preface. In: Lipkin M Jr, Putnam SM, Lazare A, editors. The medical interview: clinical care, education and research. New York: Springer; 1995. pp. Ix–Ii.CrossRefGoogle Scholar
  3. 3.
    Rosen D. Vital conversations: improving communication between doctors and patients. New York: Columbia University Press; 2014.CrossRefGoogle Scholar
  4. 4.
    Orgel E, McCarter R, Jacobs S. A failing medical educational model: a self-assessment by physicians at all levels of training of ability and comfort to deliver bad news. J Palliative Med. 2010;13(6):677–83.CrossRefGoogle Scholar
  5. 5.
    Janvier A, Lantos J. Ethics and etiquette in neonatal intensive care. JAMA Pediatr. 2014;168(9):857–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Browning DM, Meyer EC, Truog RD, Solomon MZ. Difficult conversations in health care: cultivating relational learning to address the hidden curriculum. Acad Med. 2007;82(9):905–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Meyer EC, Sellers DE, Browning DM, McGuffie K, Solomon MZ, Truog RD. Difficult conversations: improving communication skills and relational abilities in health care. Pediatr Crit Care Med. 2009;10(3):352–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Meyer EC, Brodsky D, Hansen AR, Lamiani G, Sellers DE, Browning DMA. Interdisciplinary, family-focused approach to relational learning in neonatal intensive care. J Perinatol. 2011;31(3):212–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Haq C, Steele DJ, Marchand L, Seibert C, Brody D. Integrating the art and science of medical malpractice: innovations in teaching medical communication skills. Fam Med. 2004;36(Suppl):43–50.Google Scholar
  10. 10.
    Starmer AJ, Spector ND, Srivastava R, West DC, Rosenbluth G, Allen AD, Elizabeth L, Noble EL, Tse LL, Dalal AK, Keohane CA, Lipsitz SR, Rothschild JM, Wien MF, Yoon CS, Zigmont KR, Wilson KM, O’Toole JK, Solan LG, Aylor M, Bismilla Z, Coffey M, Mahant S, Blankenburg RL, Destino LA, Everhart JL, Patel SJ, Bale JF, Spackman JB, Stevenson AT, Calaman S, Cole S, Balmer DF, Hepps JH, Lopreiato JO, Yu CE, Sectish TC, Landrigan CP for the I-PASS Study Group. Changes in medical errors after implementation of a handoff program. NEJM. 2014;371:1803–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Berkenstadt H, Haviv Y, Tuval A, Shemesh Y, Megrill A, Perry A, et al. Improving handoff communications in critical care: utilizing simulation-based training toward process improvement in managing patient risk. Chest. 2008;134(1):158–62.PubMedGoogle Scholar
  12. 12.
    Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf. 2006;32(3):167–75.PubMedGoogle Scholar
  13. 13.
    Chaaharsoughi NT, Ahrari S, Alikhah S. Comparison the effect of teaching of SBAR technique with role play and lecturing of communication skill of nurses. J Caring Sci. 2014;3(2):141–7.Google Scholar
  14. 14.
    Black SA, Nestel D, Tierney T, Amygdalos I, Kneebone R, Wolfe JHN. Gaining consent for carotid surgery: a simulation-based study of vascular surgeons. Eur J Endovasc Surg. 2009;37:134–9.CrossRefGoogle Scholar
  15. 15.
    Spofford CM, Szeluga DJ. From beginning to end in anesthesia: a 3 part series on obtaining informed consent, handling a difficult airway and delivering bad news. Simul Healthc. 2013;8(4):262–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Kolarick RC, Walker G, Arnold RM. Pediatric resident education in palliative care: a needs assessment. Pediatrics. 2006;117:1949–54.CrossRefGoogle Scholar
  17. 17.
    Horowitz N, Ellis J. Paediatric SpRs’ experiences of breaking bad news. Child Care Health Dev. 2007;33(5):625–30.CrossRefGoogle Scholar
  18. 18.
    Fallowfield L, Jenkins V. Communicating sad, bad and difficult news in medicine. Lancet. 2004;363:312–19.CrossRefPubMedGoogle Scholar
  19. 19.
    Finaly I, Dallimore D. Your child is dead. BMJ. 1991;302:1524–5.CrossRefGoogle Scholar
  20. 20.
    Orlander JD, Fincke BG, Hermanns D, Johnson GA. Medical residents’ first clearly remembered experiences of giving bad news. J Gen Intern Med. 2002;11:825–31.CrossRefGoogle Scholar
  21. 21.
    Colletti L, Gruppen L, Barclay M, Stern D. Teaching students to break bad news. Am J Surg. 2001;182:20–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Tobler K, Grant E, Marczinski C. Evaluation of the impact of a simulation-enhanced breaking bad news workshop in pediatrics. Simul Healthc. 2014;9:213–19.CrossRefPubMedGoogle Scholar
  23. 23.
    Overly FL, Sudikoff SN, Duffy S, Anderson A, Kobayashi L. Three scenarios to teach difficult discussions in pediatric emergency medicine: sudden infant death, child abuse with domestic violence and medication error. Simul Healthc. 2009;4:114–30.CrossRefPubMedGoogle Scholar
  24. 24.
    Park I, Gupta A, Mandani K, Haubner L, Peckler B. Breaking bad news education for emergency medicine residents: a novel training module using simulation with the SPIKES protocol. J Emerg Trauma Shock. 2010;3(4):385–8.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Institute of Medicine Committee on Quality of Health Care in America. To err is human: building a safer health system. Washington, D. C.: National Academies Press (US); 2000. (Kohn LT, Corrigan JM, Donaldson MS, editors)Google Scholar
  26. 26.
    Chan DK, Gallagher TH, Reznick R, Levinson W. How surgeons disclose medical errors to patients: a study using standardized patients. Surgery. 2005;138(5):851–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Stroud L, McIllroy J, Levinson W. Skills of internal medicine residents in disclosing medical errors: a study using standardized patients. Acad Med. 2009;84(12):1803–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Hardoff D, Schonmann S. Training physicians in communication skills with adolescents using teenage actors as simulated patients. Med Educ. 2001;35(3):206–10.CrossRefPubMedGoogle Scholar
  29. 29.
    Hardoff D, Benita S, Ziv A. Simulated-patient-based programs for teaching communication with adolescents: the link between guidelines and practice. Georgian Med News. 2008;156:80–3.PubMedGoogle Scholar
  30. 30.
    Hardoff D, Danziger Y, Reisler G, Stoffman N, Ziv A. Minding the gap: training in adolescent medicine when formal training programmes are not available. Arch Dis Child Educ Pract Ed. 2009;94(5):157–60.CrossRefPubMedGoogle Scholar
  31. 31.
    Beyth Y, Hardoff D, Rom E, Ziv A. A simulated patient-based program for training gynecologists in communication with adolescent girls presenting with gynecological problems. J Pediatr Adolesc Gynecol. 2009;22:79–84.CrossRefPubMedGoogle Scholar
  32. 32.
    Doolen J, Giddings M, Johnson M, Guizado de Nathan G, O Badia L. An evaluation of mental health simulation with standardized patients. Int J Nurs Educ Scholarsh. 2014;11.Google Scholar
  33. 33.
    Kameg K, Howard VM, Clochesy J, Mitchell AM, Suresky JM. The impact of high fidelity human simulation on self-efficacy of communication skills. Issues Ment Health Nurs. 2010;31(5):315–23.CrossRefPubMedGoogle Scholar
  34. 34.
    Greenburg L, Ochsenschlager D, O’Donnell R, Mastruserio J, Cohen G. Communicating bad news: a pediatric department’s evaluation of a simulated intervention. Pediatrics. 1999;103:1210–17.CrossRefGoogle Scholar
  35. 35.
    Schildmann J, Kupfer S, Burchardi N, Vollmann J. Teaching and evaluation of breaking bad news: a pre-post evaluation study of a teaching intervention for medical students and a comparative analysis of different measurement instruments and raters. Patient Educ Couns. 2012;86(2):210–19.CrossRefPubMedGoogle Scholar
  36. 36.
    Amiel GE, Ungar L, Alperin M, Baharier Z, Cohen R, Reis S. Ability of primary care physicians to break bad news: a performance based assessment of an educational intervention. Patient Educ Couns. 2006;60(1):10–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Bell SK, Pascucci R, Fancy K, Coleman K, Zurakowski D, Meyere EC. The educational value of improvisational actors to teach communication and relation skills: perspectives of interprofessional learners, faculty and actors. Patient Educ Couns. 2014;96(3):381–8.CrossRefPubMedGoogle Scholar
  38. 38.
    TeamSTEPPS and SBAR material. http://teamstepps.ahrq.gov.

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Jennifer R. Reid
    • 1
  • Kimberly P. Stone
    • 1
  • Elaine C. Meyer
    • 2
  1. 1.Department of Pediatrics, Division of Emergency MedicineUniversity of Washington School of Medicine, Seattle Children’s HospitalSeattleUSA
  2. 2.Department of Psychiatry, Institute for Professionalism and Ethical PracticeHarvard Medical School, Boston Children’s HospitalBostonUSA

Personalised recommendations