Talking the talk: Teach new residents effective communication techniques
For first-year residents, the trek to becoming an independent practitioner starts now. Chances are, much of July was spent training them on basic program functions. Now, it's time to get into the more meaty material. One of the first lessons residents must learn is how to efficiently communicate.
Taking time to teach essential communication skills at the onset of residents' training will jumpstart the learning curve. Reviewing proper communication etiquette also serves as a positive refresher for senior residents, says Yvonne Murphy, MD, associate program director for education in the MacNeal Family Medicine residency in Berwyn, Ill.
As one of the ACGME's six core competencies, program directors will teach interpersonal and communication skills throughout a resident's tenure. However, Murphy suggests program directors waste no time getting new residents up to speed in three essential areas:
- Breaking bad news to patients
- Communicating face-to-face with colleagues
- Electronic communication (e-mail, social media, etc.) with colleagues and patients
Three steps for breaking bad news
First-year residents new to the clinical environment will encounter high-stress situations, such as breaking bad news to a patient or a patient's family. Developing a game plan for these situations will help residents better manage sensitive conversations. Instruct residents to follow the following three steps for preparation and delivery, says Murphy:
- Research the patient's condition and have facts about the prognosis on hand
- Communicate with specialists who may become involved with future treatments
- Discuss the most likely treatment for the patient with the specialists
- Determine who should attend the meeting
- Find a secure and private setting for the meeting
- Step 2: Determine patient's current knowledge. Once the resident has a full understanding of the prognosis and treatment information, he or she should determine the patient's current understanding of his or her condition. Residents should also get an idea of how much detail the patient wants his or her family to know.
- Step 3: Delivering the news. The meeting now takes place with the resident, patient/family, and other parties. Prior to the meeting, give residents the following tips:
- Use specific terms to help the patient understand the prognosis
- After delivering the bad news, allow the patient's party to absorb the news
- Listen to the patient
- Respond to his or her emotional tone
- Lay out the next steps for the patient
- Step 4: Lay out the next steps for the patient. The resident should conclude the meeting by reviewing when the patient will be seen next, what additional tests or treatments are needed, and what support programs are availble to the patient to help him or her cope.
Format these steps into a checklist so residents do not overlook important aspects of patient-physician communication.
Although the framework is helpful, it only goes so far if residents do not use it effectively.
"The first time a resident delivers bad news shouldn't be with the patient," Murphy says. "Have residents walk through these steps ahead of time to prepare. The more senior residents can just review the steps, but newer residents must walk through the steps to see and feel what they look like."
Encourage residents to role-play with one another or faculty members. This allows residents to observe their own conduct and thought processes while communicating, says Murphy. During the exercise, they should self-evaluate their skills and seek feedback from their partners.
"Tell residents to pay attention to their own emotional response to delivering the bad news, so they are more aware and prepared when communicating it to the patient," Murphy says.
If residents struggle with communicating the bad news, program directors and/or faculty members should:
- Advise on how to handle communicating the message
- Provide information on resident support groups that discuss issues such as breaking bad news to patients
- Encourage residents to address the mental toll of caring for sick patients by speaking with their religious or spiritual leaders, such as priests or rabbis
Another area newer residents face, requiring similar preplanning steps to effectively communicate, is advanced care planning. See below for a checklist on steps for successfully communicating advanced care planning.
Tips to encourage peer-to-peer communication
The beginning of the academic year is the best time to reinforce essential communication skills with new residents: namely, how best to communicate with peers and attending physicians.
First-year residents often hesitate to speak up when they do not understand a critical piece of information a peer is giving them or instructions from an attending physician. Consider the following tips to give junior residents a voice on the floor:
Rules for e-communication
With smartphones, tablets, and email, residents have many ways to communicate without ever being in the same room. Program leaders should develop policies outlining rules and guidelines for social media and electronic devices and present them to new residents at the start of the academic year, says Murphy.
Begin by teaching residents the first and golden rule of email: Every email sent is permanent, discoverable, and can be used as evidence in court. Although most residents are most likely well versed in how to use the email system, explaining the legal consequences of sending unprofessional email can open eyes.
Explain that every email used by the hospital system is backed up on servers and can be used in court years after they are sent. Remind residents that forwarding emails to unintended parties is more common than they might expect, and it can lead to consequences.
Emailing a patient is a matter of legality as well. Any email a resident sends to a patient is automatically part of the patient's record. Faculty members should review all email communications a resident has with a patient prior to sending the email, says Martin.
Clearly define the situations in which email is appropriate. For example, when communicating a large volume of information to other colleagues, an email serves as useful review, especially if a physician or another resident must recall the information days later, such as at an office follow up visit after a hospitalization.
Social media is another helpful tool for which program directors need to set guidelines. Educate residents on the professional implications of posting information to social media sites. Review hospital policy as well as necessary security settings for each social media site-these may not be settings that social media users have used on their personal pages, says Martin.
"Social media is second nature to this generation of residents. Without guidelines, they may overlook the importance of communicating professionally," she says.