Improving child neurology residents’ communication skills
When pediatric neurology residents enter their training program, they may quickly recognize one of the biggest challenges posed by the profession: clear, effective, empathetic doctor-patient communication.
Implementing effective communication skills in pediatric neurology trainees provides a unique challenge with many obstacles. In addition to translating complex clinical terminology into a layperson’s terms at a range of developmental levels, clinicians also need to adjust their language to address the fact that many patients lack a basic understanding of the nervous system. Furthermore, the manner in which child neurologists deliver distressing information to patient and family can heavily influence how such information is processed. It can be daunting for trainees to approach such interactions with empathy and support. Though elements of effective communication can be taught, medical residents need consistent practice and mentorship.
Dara Albert, DO, MEd, associate program director of Child Neurology Residency at Nationwide Children’s Hospital and assistant professor of Pediatrics at The Ohio State University College of Medicine, and her team find further complications in the formal assessment of communication skills, as such tools are limited. While the objective structured clinical examination (OSCE) effectively examines resident knowledge and oral delivery skills, there was no published research on its application for child neurologists. To address this, Dr. Albert partnered with staff at the Clinical Skills Education and Assessment Center at the Ohio State College of Medicine to design a program. She and her team published their findings, An Objective Structured Clinical Examination of Communication Skills for Child Neurology Residents, in Pediatric Neurology, January 2021.
“We sought to develop a set of standardized cases that can be used as a low-stakes formative assessment of communication skills for child neurology residents,” the authors wrote. “We aimed to evaluate the feasibility of implementation, perceived utility for the residents and correlation between multiple observers in evaluating resident skills.”
Consisting of nine standardized clinical scenarios, the study involved having trainees discuss assigned scenarios with standardized patient actors. Following their performance, Dr. Albert and her team asked standardized patients and faculty observers to provide direct verbal feedback to the participants. After the event, trainees were invited to view a video of their performance and reflect on key takeaways of their performance.
Following the initial study, Dr. Albert and her team found that all nine scenarios effectively employed patient-clinician communication. Participants and faculty found the case portrayals to be realistic, with many trainees finding the OSCE to be beneficial to their education.
Although trainees scored themselves lower than standardized patients and faculty, they found the experience overall improved their clinician-patient communication skills. Each party expressed differing views on the primary skill obtained from this program. Trainees found they best improved relationship-building skills, while standardized patients rated “communicates accurate information” to be the strongest skill obtained. Faculty rated empathy demonstration as the highest skill score.
“We found this activity useful for resident education and a rare opportunity for trainees to receive direct feedback about their communication from simulated patients and families. The breadth of common but challenging clinical scenarios mirrored pediatric neurology practice and allowed multiple opportunities to observe and evaluate communications skills,” the authors wrote.
This project was supported by a grant from the American Board of Psychiatry and Neurology, the Faculty Innovation in Education Award.