The Surgical Resident Communication Experience: A Prospective Observational Needs Assessment.

Background: Skillful communication is a vital part of a surgeon's toolkit. Surgical resident day-to-day communication tasks include conducting informed consent discussions, guiding families through end-of-life conversations, coordinating care with colleagues, and demonstrating competence to educators. It is not known which are most challenging and therefore should be prioritized in training. To date, no studies have prospectively captured the communication activities of surgical residents and their sense of comfort and competence performing these varied tasks.

Methods: We performed a prospective observational study of surgical residents and their communication during meetings with patients, families, and colleagues in the clinical setting. Researchers recorded location and length of encounters, goal and topic of conversations, resident reflections, and researcher observations. Resident comments and researcher field notes were analyzed for the range of experiences and common themes.

Results: A total of 300 encounters were recorded from 23 residents, with 60% (n=175) involving interns. Half occurred on the medical-surgical wards and lasted under five minutes. Interns rated encounters lowest when facing unfamiliar clinical protocols, non-standardized care, interpreter technology challenges, and frequent electronic interruptions. More experienced residents cited frustration with other professionals or services and unclear processes for recurring situations. Senior residents expressed less distress than juniors when navigating unfamiliar clinical situations. Interns often internalized conflicts, attributing challenges to their lack of experience and knowledge, while senior residents tended to externalize similar frustrations, citing others' missteps. Across all levels, high-stakes discussions with patients and families were seen as challenging, but not as distressing as hospital systems, technological issues, and colleague disagreements.

Conclusion: Our findings inform recommendations for topics to include in training, such as negotiating conflicting clinical plans, managing poorly defined consults, and supporting families despite strict time constraints. Longitudinal and multi-institutional data collection would provide more insight into communication training needs.