Communication Skills for Neurosurgeons:Neurosurgery Boot Camp 2

Michael M. Haglund MD, PhD, FCS (ECSA)Distinguished Professor of Neurosurgery, Neurobiology, & Global Health

Program and Training Director, Duke NeurosurgeryCo-Director Uganda Neurosurgery Training Program

Surgical Director, Duke Epilepsy Centerand

Neil Prose MDProfessor of Pediatrics and Dermatology

Duke University Health System Durham, North Carolina

Supported by a Dr. Dzau Duke GME Innovation Grant

Duke University Medical CenterDurham, North Carolina, USA

Communication Skills for Surgeons

“The single biggest problem with communication is the illusion it has taken place” George Bernard Shaw

Communication Skills for NeurosurgeonsNational Survey of NSU Program Directors (response rate: 92%)Skill in Communication Milestones

Milestone Description: Interpersonal and Communication Skills - Relational

Level 1 Level 2 Level 3 Level 4 Level 5

Describe the ethical principles of informed consent.

Describe methods to compassionately break bad news.

Identify elements of safe patient hand offs and procedural pause.

Prioritize and convey simultaneous critical clinical events.

Obtain and document informed consent.

Participate in breaking bad news to a patient or family.

Participate in an advanced directive discussion.

Lead procedural pause.

Use checklists and informatics to support patient hand offs.

Communicate effectively with patients and families from varied cultural and socioeconomic backgrounds.

Prioritize, convey, and manage simultaneous critical clinical events.

Obtain and document informed consent in challenging circumstances (e.g. language or cultural barrier).

Break bad news to a patient or family member.

Lead and document an advanced directive discussion.

Supervise patient hand offs.

Communicate effectively with physicians, health professionals, and health agencies.

Quantify evidence for risk-benefit analysis during informed consent for a complex, elective neurosurgical procedure.

Manage and document an unexpected outcome (e.g. patient, care team and risk management communication).

Lead response to an intra-operative or critical care emergency.

Act in a consultative role to other physicians.

Design consent instrument for a human subject research study; file an IRB application.

Design and implement a procedural safety or sign out exercise.

Design and implement a team building and communications exercise.

Comments:

Communication Skills for Neurosurgeons

8 of 23 fully or partially covered

Communication Skills for Surgeons

Bad scenario

Delivering Bad News:Look for three things Dr. Anderson could have done better:

Communication Skills for Surgeons

Good scenario

Delivering Bad News:Of the three things you listed, check off if Dr. Anderson did them

Communication Skills for Neurosurgeons

Delivering Bad News:1. Sit down2. start with an Open ended question3. Listen4. Say back what you heard

pneumonic: SOLS

5. Fire a “warning shot” and give news in a direct way6. Allow them to absorb information7. Ask permission to proceed8. Explain in clear language9. Offer support10. “What questions do you have?”

Communication Skills for NeurosurgeonsDuke Neurosurgery Residents (14/17)Pilot StudyNovember 2012, Two hour session, Five videos

Communication Skills for Neurosurgeons

Pilot Study: Duke Neurosurgery Residents (15/17)November 2012, Two hour session, Five videos

Communication Skills for NeurosurgeonsTaking a History:Look for three things Dr. Anderson could have done better:

Bad scenario

Communication Skills for NeurosurgeonsTaking a History:Of the three things you listed, check off if Dr. Anderson did them

Good scenario

Communication Skills for Neurosurgeons

Taking a History:1. Sit down2. start with an Open ended question3. Listen4. Say back what you heard

5. Explain the plan in clear language 6. Offer support7. “What questions do you have?”

Communication Skills for NeurosurgeonsGetting Informed Consent:Look for three things Dr. Anderson could have done better:

Bad scenario

Communication Skills for NeurosurgeonsGetting Informed Consent:Of the three things you listed, check off if Dr. Anderson did them

Good scenario

Communication Skills for Neurosurgeons

Obtaining Informed Consent:1. Sit down2. Start with an Open ended question3. Listen4. Say back what you heard

5. Explain the plan in clear language 6. Offer support7. “What questions do you have?”

Communication Skills for NeurosurgeonsDelivering a Disappointing Outcome:Look for three things Dr. Anderson could have done better:

Bad scenario

Communication Skills for NeurosurgeonsDelivering a Disappointing Outcome:Of the three things you listed, check off if Dr. Anderson did them

Good scenario

Communication Skills for Neurosurgeons

Delivering a Disappointing Outcome:1. Sit down2. Fire a “warning shot” and give news in a direct way3. Allow patient to absorb information4. Ask permission to proceed5. Apologize when appropriate6. Explain the result in clear language 7. Recognize emotions8. Offer hope and reassurance9. “What questions do you have?”

Communication Skills for Neurosurgeons

Summary: Taking History and Informed Consent1. Sit down2. Start with an Open ended question3. Listen4. Say back what you heard

SOLS5. Explain the plan in clear language 6. Offer support7. “What questions do you have?”

Communication Skills for NeurosurgeonsSummary:Delivering Bad News or a Disappointing Outcome:1. Sit down2. Start with an open question3. Listen4. Say back what you heard

5. Fire a “warning shot” and give news in a direct way6. Allow them to absorb information7. Ask permission to proceed8. Apologize when appropriate (disappointing outcome)

9. Explain in clear language10. Offer support11. “What questions do you have?”