Lauren J Taylor1, Sarah Adkins2, Andrew W Hoel3, Joshua Hauser4, Pasithorn Suwanabol5, Gordon Wood4, Wendy Anderson2, Carolina Branson6, Steven Skube6, Sara K Johnson7, Amy Zelenski7, Jennifer L Tucholka1, Toby C Campbell7, Margaret L Schwarze8. 1. Department of Surgery, University of Wisconsin. Madison, Wisconsin. 2. Department of Medicine. University of California San Francisco. San Francisco, California. 3. Division of Vascular Surgery, Northwestern University Feinberg School of Medicine. Chicago, Illinois. 4. Department of Medicine, Northwestern University Feinberg School of Medicine. Chicago, Illinois. 5. Department of Surgery, University of Michigan. Ann Arbor, Michigan. 6. Department of Surgery, University of Minnesota. Minneapolis, Minnesota. 7. Department of Medicine, University of Wisconsin. Madison, Wisconsin. 8. Department of Surgery, University of Wisconsin. Madison, Wisconsin; Department of Medical History and Bioethics. University of Wisconsin. Madison, Wisconsin. Electronic address: schwarze@surgery.wisc.edu.
Abstract
OBJECTIVE: Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity. DESIGN, SETTING, AND PARTICIPANTS: We used the Replicating Effectiveness Programs framework to guide our implementation strategy and tested our intervention with 39 surgical residents at 4 institutions from September 2016 to June 2017. The implementation package consisted of: (1) instructional video, (2) checklist to assess competence, (3) learner manual, and (4) instructor manual. We focused on 3 implementation outcomes: feasibility, fidelity, and acceptability to participants. RESULTS: Attendance rates ranged from 16% to 75%. Site leaders had little difficulty identifying suitable instructors; however, resident recruitment proved challenging. Sixty-nine percent of residents completed the post-training assessment and the mean score was 12.8 (range 8-15) using the 15-point checklist. Across sites, 69% strongly agreed that Best Case/Worst Case is better than how they usually approach high-stakes conversations and 100% felt prepared to use the tool after training. Instructors reported that the training provided residents with the necessary skills to perform the fundamental elements of Best Case/Worst Case. CONCLUSIONS: Using implementation science we demonstrated that a resource intensive communication training intervention can be successfully modified for group-learning and wide-scale dissemination. However, we identified barriers to implementation, including challenges with feasibility and programmatic buy-in that inform not only resident education but also communication skills training more broadly.
OBJECTIVE: Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity. DESIGN, SETTING, AND PARTICIPANTS: We used the Replicating Effectiveness Programs framework to guide our implementation strategy and tested our intervention with 39 surgical residents at 4 institutions from September 2016 to June 2017. The implementation package consisted of: (1) instructional video, (2) checklist to assess competence, (3) learner manual, and (4) instructor manual. We focused on 3 implementation outcomes: feasibility, fidelity, and acceptability to participants. RESULTS: Attendance rates ranged from 16% to 75%. Site leaders had little difficulty identifying suitable instructors; however, resident recruitment proved challenging. Sixty-nine percent of residents completed the post-training assessment and the mean score was 12.8 (range 8-15) using the 15-point checklist. Across sites, 69% strongly agreed that Best Case/Worst Case is better than how they usually approach high-stakes conversations and 100% felt prepared to use the tool after training. Instructors reported that the training provided residents with the necessary skills to perform the fundamental elements of Best Case/Worst Case. CONCLUSIONS: Using implementation science we demonstrated that a resource intensive communication training intervention can be successfully modified for group-learning and wide-scale dissemination. However, we identified barriers to implementation, including challenges with feasibility and programmatic buy-in that inform not only resident education but also communication skills training more broadly.
Authors: Terrance Peng; Albert J Farias; Kimberly A Shemanski; Anthony W Kim; Sean C Wightman; Scott M Atay; Robert J Canter; Elizabeth A David Journal: JTCVS Open Date: 2022-04-28
Authors: Cole Hooley; Ana A Baumann; Vincent Mutabazi; Angela Brown; Dominic Reeds; W Todd Cade; Lisa de Las Fuentes; Enola K Proctor; Stephen Karengera; Kenneth Schecthman; Charles Goss; Pascal Launois; Victor G Davila-Roman; Eugene Mutimura Journal: Pilot Feasibility Stud Date: 2020-05-15
Authors: Suchitra Rao; Bethany M Kwan; Donna J Curtis; Angela Swanson; Leigh Anne Bakel; Lalit Bajaj; Juri Boguniewicz; Justin M Lockwood; Kaleigh Ogawa; Katherine Pemberton; Robert C Fuhlbrigge; David Brumbaugh; Patricia Givens; Eva S Nozik; Marion R Sills Journal: J Pediatr Date: 2020-10-20 Impact factor: 4.406