Improving Communication Skills of Residents Using Family Meeting Simulation Exercises

Abstract

Introduction

Effective communication skills are important to deliver serious news. Applying Kolb's experiential learning theory, we evaluated the impact of a mini-lecture and simulation-based curriculum to improve communication skills and confidence of residents delivering bad news during a Medical Intensive Care Unit (MICU) rotation.

Methods

We performed an educational intervention for 26 internal medicine residents on their MICU rotation. Each resident first underwent a Mini-Clinical Evaluation Exercise (Mini-CEX) family meeting simulation with untrained actors, where they were observed and evaluated by two MICU attendings using a standardized modified SPIKES protocol evaluation tool. One week later, a 30-min PowerPoint interactive lecture on the SPIKES protocol was presented by a Chief Medical Resident. A post-didactic Mini-CEX was held 1 week after the lecture. Residents also completed a brief survey before and after the intervention to assess their level of comfort in conducting an effective family meeting.

Results

Residents were more comfortable facilitating an end-of-life family meeting after the intervention (p < 0.001). Mini-CEX scores improved on all 20 SPIKES items (all p < 0.001), and there was a significant improvement in Mini-CEX sum scores (premean = 24.7 vs. postmean = 46.1, p < 0.001). Both International Medical Graduates (IMG) and US Medical Graduates (USMG) had significantly improved scores in each component of SPIKES.

Discussion

We demonstrated that the experience of a simulated family meeting followed by a 30-min didactic on the SPIKES protocol and a post-didactic family meeting improved the skills and confidence of residents in leading family meeting discussions.