CRITICAL DIALOGUES AND REFLECTIONS: THEORY OF COMMUNICATIVE ACTION BASED CURRICULUM TO FOSTER COMPETENCY FOR JUDGMENT, CULTURE OF CARE, AND RESIDENT AUTHENTICITY AT A FAMILY MEDICINE RESIDENCY PROGRAM
Morhaf Al Achkar, MD, Assistant Professor, Family Medicine
Co-Investigator: Valerie Ross, MS, Family Medicine
Grant Amount: $4,000
Abstract: Residency programs are ascribed the intricate and complex role of training future health care providers. To move our residency closer to fulfilling this role, a Theory of Communicative Action based curriculum for resident learning will be developed. In this curriculum, residents at the University of Washington Family Medicine Residency Program will engage in critical dialogues and reflections with their peers and their attendings in small groups as they review video recordings of their interactions with their actual patients. Our theoretical framework will allow participants to engage not only in judging competency but also in dialoguing around norms and values and around their subjective authentic experiences. During these critical dialogues and reflections residents will move closer to the aims of (1) developing competency in judging clinical performance, (2) cultivating a culture of understanding and care among participants, and (3) enacting authenticity. We will use a qualitative approach to understand resident experience in this model. This innovative framework will transform training in the residency and support the educational needs of our residents.
TAKING THE NEXT STEP – IMPROVING INTERPROFESSIONAL FACULTY CURRICULUM DEVELOPMENT SKILLS
Amber K Fisher, PharmD, BCACP, Co-Directo Boise Center of Excellence in Primary Care Education, Pharmacy Residency Program Director VAMC
Co-Investigators: India King, PsyD, Clinical Instructor, Dept of Psychiatry and Behavioral Sciences.
Grant Amount: $4,000
Abstract: The Boise VAMC’s interprofessional faculty development series has involved highly skilled educators who participate in ongoing seminars and workshops to improve their teaching skills. Currently the Boise Center of Excellence in Primary Care Education (CoEPCE) faculty oversee this educational series, ensuring quality speakers, useful topics, workshops, journal clubs and other activities which are provided to a group of interprofessional clinical educators in our facility. To better engage mid-career, experienced clinical educators in effective teaching, we propose a program to support teaching faculty from different professions to develop and implement small, time limited curriculum development projects using quality improvement (QI) principles and techniques.
DEVELOPMENT AND VALIDATION OF A MILESTONE-BASED PRENATAL COUNSELING COMMUNICATION SCALE
Megan M Gray, MD, Assistant Professor, Pediatrics
- Taylor L. Sawyer DO, MEd, Associate Professor, Pediatrics – Neonatology, University of Washington
- Rachel A. Umoren MBBCh, MS, Assistant Professor of Pediatrics, Pediatrics – Neonatology, University of Washington
- Jennifer Kett MD, MA, Pediatric Complex Care Support Team, Multicare Marybridge Children’s
- Jeanne Krick MD, Neonatal and Ethics Fellow, Pediatrics – Neonatology, University of Washington
- Patrick Motz DO, MPH, Neonatal Fellow, Pediatrics – Neonatology, University of Washington
- Josephine H. Amory MD, Clinical Assistant Professor, Department of Family Medicine, Palliative
Care/ Maternal Fetal Medicine, University of Washington
- Heather French MD, MEd, Associate Clinical Professor of Pediatrics, Division of Neonatology,
Children’s Hospital of Philadelphia
Grant Amount: $5,000
Abstract: Physician-patient communication is critical to building a therapeutic relationship and ensuring patient safety but these skills are difficult to master. Prenatal counseling is particularly challenging for learners due to the life-or-death decisions being made and the need to establish a trusting therapeutic relationship with families who will often have interactions with the medical system for years to come. Despite the importance of these skills, there are no validated scales for rating the quality of prenatal counseling or providing the structured feedback that learners need to advance from novices to experts. With CLIME funding we will develop and validate a Prenatal Counseling Milestones Scale (PCMS) to assess learners across the spectrum of graduate medical education. The milestone format will enable us to identify key areas in need of development for novice providers and continuously track competency
development from the beginning of residency, to the end of fellowship training. Content validity, internal validity, and interrater reliability of the PCMS will be assessed, along with correlation with previously validated measure of empathy in the pediatric residents and fellow. Learners will also have the opportunity to receive and rate the structured feedback provided by faculty instructors using the PCMS.
ASSESSMENT OF PARAMEDIC SURGICAL SKILLS IN SIMULATED EMERGENCY CRICOTHYROTOMY
Jonathan M. Keller, MD, Clinical Instructor, Pulmonary, Critical Care and Sleep Medicine
Amy Morris, MD, Medicine – Pulmonary, Critical Care & Sleep Medicine, University of Washington
David Carlbom, MD, Medicine – Pulmonary, Critical Care & Sleep Medicine, University of Washington
Grant Amount: $3,110
Abstract: Emergency cricothyrotomy is an important surgical skillset for medicals providers who manage patient airways. Cricothyrotomy is the common final pathway among all difficult airway management algorithms. Although it is infrequently performed, the procedure is lifesaving. Studies have documented an unacceptably high failure rate in some pre-hospital settings, and discomfort with cricothyrotomy is common among pre-hospital providers given how rarely it is clinically encountered. Evaluation tools have been developed for cricothyrotomy skill assessment and provision of learner feedback, including itemized checklists and global rating instruments, but these have never been studied in pre-hospital care providers who perform the procedure. In addition, trainer time constraints pose a significant challenge in conducting formal assessment of procedural skills. “Crowdsourcing,” using large numbers of layperson non-experts, has proven to be a useful strategy to improve and expedite assessment of trainee surgical skills, including cricothyrotomy. This too has never been evaluated in first responders. We propose a study of Paramedic cricothyrotomy skill assessment using a validated rating instrument to discriminate among participant performance, comparing expert vs crowdsourced raters.
A CRUCIAL CONVERSATION: HELPING TRAINEES LEARN HOW TO TALK TO FAMILIES AFTER SURGERY
Kathleen Kieran, MD, MS, MME, Associate Professor, Urology
Grant Amount: $3,890
Abstract: In surgical subspecialties, there is little literature on how to teach, assess, and refine communication skills in residents and fellows. A minority of urologic residency programs have formal programs to teach communication skills; the vast majority endorse modeling by attendings and other residents, without formal mechanisms for feedback and practice. Success of this methodology requires attendings to consistently model ideal behavior, and residents to critically observe. Postoperative conversations (POCs) with families is one area in which residents may not get adequate practice during training: attendings often have established relationships with patients and families, and residents often handle administrative or clinical tasks between OR cases, leaving the attending to visit with the family alone. Discussions with family members after a loved one’s surgery can be challenging, requiring rapid rapport building, efficient delivery of salient information in an emotionally charged setting, and attention to time given the use of shared resources (space) and the constraints of room turnover. This project is the first step in the development of a novel curriculum, and will assess both resident and attending comfort with POCs, identify learner-focused areas for improvement, and will inform methods to help learners refine their skills with POCs with families.