1. 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.
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
Project Team: Sustainability:
• PFAs as Subject Matter Experts. • Same intervention delivered to different groups at
• Resident in combined Internal Medicine/Preventive different times showed consistent improvement in the
Medicine Program. ability to apply the knowledge learned. No data yet
• Faculty Physicians (Peds, Anes, OB/GYN), Chaplain, available that it has improved things from the
RN-Instructional Design Specialist. perspective of the patient.
• Initial work in partnership with Henry Ford Hospital. • The Always Events® framework will remain a
• Supported by a Picker Institute/Gold Foundation 2010 common thread running through all future modules.
Challenge Grant. • 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.