Abstract: SA-PO194
Breaking Bad News: A 2 Year, Multi-Center Simulation Exercise Assessing Renal Replacement Therapy and Kidney Biopsy Communication Skills
Session Information
- Educational Research
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Educational Research
- 800 Educational Research
Authors
- Prince, Lisa K., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States
- Y'Barbo, Brian C., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States
- Mikita, Jeffrey Alan, Walter Reed National Military Medical Center, Silver Spring, Maryland, United States
- Howle, Anna M., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States
- Cohen, Scott D., The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
- Lenz, Oliver, University of Miami, Miami, Florida, United States
- Maursetter, Laura J., University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
- Maynard, Sharon E., Lehigh Valley Health Network, Emmaus, Pennsylvania, United States
- Sozio, Stephen M., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Sussman, Amy Nicole, University of Arizona, Tucson, Arizona, United States
- Yuan, Christina M., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States
Group or Team Name
- Nephrology Education Research & Development Consortium
Background
There are few quantitative, simulation-based assessments for nephrology-specific interpersonal communication skills (ICS) and professionalism (PROF) milestones. We developed a “Breaking Bad News” simulation to assess fellow counseling competence in 3 scenarios: a surrogate decision maker for acute renal replacement therapy (RRT), a patient with end stage kidney disease for RRT, and a patient with glomerulonephritis for kidney biopsy.
Methods
After reviewing a clinical summary, fellows counsel each of the 3 simulated patients (SPs) who have received a summary of their character’s medical and social situation. Faculty were instructed on the scenarios, use of the Mini-CEx, and the information provided to fellows and SPs. Fellow performance was assessed using 2 previously validated tools: the Mini-Clinical Examination Exercise (Mini-CEx) and the Essential Elements of Communication-Global Rating Scale 2005 (EEC-GRS). Both have a 1-5 rating scale with scores of 3 or greater being satisfactory. SPs rate fellow ICS and PROF using the EEC-GRS, and nephrology faculty, observing from outside of the room, use the Mini-CEx to evaluate medical knowledge and ICS. Fellows receive 5 minutes on-the-spot performance feedback at the end of each 15 minute scenario from both SP and faculty.
Results
56 fellows completed the OSCE. The 2017 administration included 26 fellows (5 training programs), and the ongoing 2018 administration included 30 fellows (6 of a total 8 programs). EEC-GRS scores were not significantly different between first and second year fellows (p=0.27). No significant difference was found between training years when comparing any EEC-GRS score <3 or any Mini-CEx score <3. Only 13% of fellows scored <3 on any item in the chronic dialysis counseling Mini-CEx, while 45% and 43% respectively scored <3 on at least one item on the acute RRT counseling and kidney biopsy scenarios.
Conclusion
Overall, fellows communicate well and professionally with high ratings on EEC-GRS. Fellows counsel patients well on chronic RRT but had deficiencies in counseling on risks of acute RRT and kidney biopsy. The results allow program directors to adjust curriculum and provide quantitative assessment of ACGME milestones progress.
Funding
- Other U.S. Government Support