Teaching pediatric intensive care physicians communication skills: The enduring effects

Abstract

Objectives * Determine feasibility of a communication skills training (CST) to prepare pediatric intensivists for communicating bad news and assessing goals of care in the pediatric intensive care unit (PICU). * Describe the impact of CST on intensivist skill in communication. Original Research Background. Families of seriously ill children describe unmet needs for honest information presented empathetically, while intensivists report inadequate training in having difficult conversations. Research Objectives. 1. To determine feasibility of communication skills training (CST) to prepare pediatric intensivists for communicating bad news and assessing goals of care in the pediatric intensive care unit (PICU). 2. To describe the impact of CST on intensivist skill in communication. Methods. Intensivists volunteered to undergo CST with didactics, discussions with simulated parents, and a videotaped OSCE exam. Surveys prior to the intervention and one month after were tabulated for descriptive statistics. Wilcoxon signed-rank tests compared outcomes at 2 time points. 2 independent trained reviewers scored the OSCE using a validated tool. Results. Twelve participants completed training. In the post-CST survey, all participants agreed the training gave them skills to communicate in challenging situations, and they would recommend it to peers. When comparing pre- and post-CST self-assessment measures of intensivists’ information-seeking from families, there was a significant increase 1 month after training (p=0.03), with intensivists more likely to ask what kinds of information families need and what their understanding of their child’s disease is, but no significant changes in information seeking or giving, which was not covered in the training. Finally, 11 of the 12 intensivists received passing scores on the OSCE as measured by a validated tool, with the average score being 48.5 (SD 5.92) compared to 38.6 (SD 9.93) after training that was reported in the literature. Conclusion. This study provides evidence that intensivists are willing to participate in CST and an OSCE exam, and they find it worthwhile. There is also evidence that they perceive an improvement in their skill set as a result of having participated. Implications for Research, Policy or Practice. Offering realistic, simulation-based CST is feasible and effective for training intensivists.