NYU School

of Medicine

CAN PROFESSIONALISM BE TAUGHT?

FINALLY THERE IS EVIDENCE

Department of SurgeryNew York University School of MedicineApril 29, 2009

NYU School

of Medicine

Mark Hochberg, MDAdina Kalet, MD

Sondra Zabar, MDElizabeth Kachur, PhDColleen Gillespie, PhD

Russell Berman, MD

NYU School

of Medicine

NYU SCHOOL OF MEDICINE CAMPUS

NYU School

of Medicine

ACGME COMPETENCIES

• Patient Care

• Medical Knowledge

• Practice- Based Learning and Improvement

• Interpersonal and Communication Skills

• Professionalism

• Systems-Based Practice

NYU School

of Medicine

NYU School

of Medicine

THE CHALLENGE

Teaching and Assessing the ACGME competencies of Professionalism and Communication Skills to surgical resident learners

NYU School

of Medicine

ACGME PROFESSIONALISM & COMMUNCATION COMPETENCIES

Interpersonal Skills– Info Gathering– Relationship

Development– Patient Education

and Counseling

Ethics– Informed consent– Impaired colleague– Managing difficult

situations

Accountability– Admitting mistakes

Altruism

Sensitivity to Patients– Respect patient

values– Shared decision-

making– Cultural competence

Respect– Interdisciplinary

Respect

NYU School

of Medicine

Pre OSCE*

July 2007

POST OSCE

July 2008

SPICE CurriculumSix Interactive

Sessions

SURGICAL PROFESSIONALISM and INTERPERSONAL COMMUNICATION EDUCATION (SPICE)

*Objective structured clinical examination

NYU School

of Medicine

THE CURRICULUM – SIX ONE HOURINTERACTIVE SESSIONS

• Advanced communication skills in surgical practice: How the pros do it

• Admitting mistakes: How you can become more humane

• Delivering bad news: Your chance to become a master surgeon

• Interdisciplinary respect: Working as a team• Working across language and cultural barriers:

Ensuring a truly informed consent• Self-care of you and your family: The stress

of surgical practice

NYU School

of Medicine

TEACHING METHODS

• Brief Mini-lecture• Popular TV show

video vignettes as trigger for discussion

• Resident team building exercises

• Video re-enactments of “the good, the bad and the ugly”

• Faculty and chief resident role modeling standardized patients

VIDEO CLIPS FROM GREY’S ANATOMYVIDEO CLIPS FROM GREY’S ANATOMY

NYU School

of Medicine

• Six Station OSCE

• 15 residents (R1s,R2s,R3s)

• Behaviorally anchored checklist rated by trained standardized patients– Not Done, Partly Done, Well Done– Communication: overall & three domains– Professionalism: overall & four domains

• Scores % well done

ASSESMENT METHODS

NYU School

of Medicine

THE OSCE SCENARIOS1. Hernia repair – reporting wrong sided surgery to

patient2. Delivering bad news – explaining an unexpected OR

death to the spouse3. Use of an interpreter – using an interpreter to describe

proposed breast operation4. Taking a signout – identifying a resident colleague as

an impaired physician5. Patient transfer – receiving a phone request from ER

to accept a patient with a venous stasis ulcer (i.e. "dump"”)

6. Health proxy – Explaining to a patient's daughter that the patient’s signed proxy supersedes daughter’s wishes

NYU School

of Medicine

EXAMPLE: DELIVERING BAD NEWS

NYU School

of Medicine

% W

ell D

one

COMPARISON OF PRE AND POST PROFESSIONALISM CURRICULUM DATA (n=15)

45%36%

55%

45%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

OVERALL COMMUNICATION OVERALL PROFESSIONALISM

Pre- Curriculum '07Post-Curriculum '08

p=0.020

p=0.011

Error bars: +/- 1 Std Dev

NYU School

of Medicine

% W

ell D

one

COMPARISON OF PRE AND POST CURRICULUMSPECIFIC COMMUNICATION DOMAINS (n=15)

58%

49%

23%

70%

54%

39%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Information Gathering RelationshipDevelopment

Patient Education &Counseling

Pre- Curriculum '07Post-Curriculum '08

Error bars: +/- 1 Std Dev

p=0.043

p=0.120

p=0.017

NYU School

of Medicine

49%43%

32%

24%

54% 54%48%

38%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Accountability Being Sensitive toPatient

Working with anInterpreter

Giving Bad News

Pre- Curriculum '07

Post-Curriculum '08

COMPARISON OF PRE AND POST CURRICULUMSPECIFIC PROFESSIONALISM DOMAINS (n=15)

p=0.453

p=0.021

p=0.027 p=0.049

Error bars: +/- 1 Std Dev

NYU School

of Medicine

COMPARISON OF PRE AND POST CURRICULUM: STANDARDIZED PATIENT (SP) RECOMMENDATIONS (n=15)

2.64

3.19

1.00

1.50

2.00

2.50

3.00

3.50

4.00

SP Satisfaction

Pre- Curriculum '07

Post-Curriculum '08

Not

Highly

With Reservations

RecommendThe error bars: +/- 1 Std Dev

P<0.001

NYU School

of Medicine

CONCLUSIONS• The ACGME competencies of Professionalism

and Communication Skills can be positively impacted by six one-hour evidence based, interactive learning sessions

• This curriculum is feasible and acceptable to residents and faculty and improves patient satisfaction with their doctors

NYU School

of Medicine

NEXT STEPS

• Multi-institutional study to assess generalizability

• Hoping to recruit surgical educators at AMCs

• We propose to share our curriculum and assessment materials

NYU School

of Medicine

NYU School

of Medicine

THANK YOU!

NYU School

of Medicine

Extra SlidesFor Questions

NYU School

of Medicine

NYU School

of Medicine

NYU School

of Medicine

NYU School

of Medicine

o15 Surgery Residents completed Pre and Post OSCEs and participated in SPICE Curriculum–7 PGY 1s

–4 PGY 2s

–4 PGY 3s

Of 24 Total Residents

NYU School

of Medicine

OSCE Scores# Items

(# Cases)Cronbach’

s Alpha

Communication 11 items (6 cases)

.65

Information Gathering 3 items (6 cases) .62

Relationship Development 5 items (6 cases) .72

Patient Education and Counseling 3 items (6 Cases) .62

Professionalism 53 items (6 cases)

.62

Accountability 10 items (3 cases) .61

Giving Bad News 7 items (2 cases) .58

Working with an Interpreter 5 items (1 case) .55

Being Sensitive to Patient 15 items (5 cases) .60

NYU School

of Medicine

• Interpersonal and Communication Skills– Information Gathering– Relationship Development– Patient Education and Counseling

• Professionalism– Accountability– Interdisciplinary Respect– Managing Difficult Situations

• Giving Bad News• Responding to Emotions

– Being Sensitive to Patient• Working with an Interpreter• Respect Patient Values• Shared Decision-Making

NYU School

of Medicine

Teaching Principles

• OSCEs are the perfect tool• Administered in July and again in June to R1, R2

and R3 learners• Have been repeatedly validated as an

assessment tool• Great care taken to write realistic scenarios and

scrupulously train the actors• Actors given detailed grading sheets for the

differing scenarios to assess if learners tasks were “well done”, “partially done” or “not done”

NYU School

of Medicine

o 8 residents completed the post-test OSCE but NOT the pre-test (but did participate in SPICE)– Allowing for an estimate of effect of pre-test

44%

36%

50%

39%

55%

46%

0%

10%

20%

30%

40%

50%

60%

OVERALL COMMUNICATION OVERALL PROFESSIONALISM

Pre Post w/out Pre Post w/ Pre

NYU School

of Medicine

70%

44%

89%

68%

81%

51%

38%

47%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Communication Scores for Resident ID #

Your Scores Class Mean

% W

ell D

on

e

OVERALL COMMUNICATION

SCORE

Communication -Information Gathering

Communication -Relationship Development

Communication -Patient

Education

Error Bars: +/- 1 Std Dev

NYU School

of Medicine

CONCLUSIONS

Through the use of an interactive curriculum, standardized patients and the OSCE, we have shown that the ACGME core competencies of Professionalism and Communication Skills can be effectively taught to surgical resident learners – and can positively effect their patient interactions