• Alison M Bays, Ruth A Engelberg, Anthony L Back, Dee W Ford, Lois Downey, Sarah E Shannon, Ardith Z Doorenbos, Barbara Edlund, Phyllis Christianson, Richard W Arnold, Kim O'Connor, Erin K Kross, Lynn F Reinke, Laura Cecere Feemster, Kelly Fryer-Edwards, Stewart C Alexander, James A Tulsky, and J Randall Curtis.
• 1 Department of Medicine, University of Washington , Seattle, Washington.
• J Palliat Med. 2014 Feb 1;17(2):159-66.

BackgroundCommunication with patients and families is an essential component of high-quality care in serious illness. Small-group skills training can result in new communication behaviors, but past studies have used facilitators with extensive experience, raising concerns this is not scalable.ObjectiveThe objective was to investigate the effect of an experiential communication skills building workshop (Codetalk), led by newly trained facilitators, on internal medicine trainees' and nurse practitioner students' ability to communicate bad news and express empathy.DesignTrainees participated in Codetalk; skill improvement was evaluated through pre- and post- standardized patient (SP) encounters.Setting And SubjectsThe subjects were internal medicine residents and nurse practitioner students at two universities.Intervention And MeasurementsThe study was carried out in anywhere from five to eight half-day sessions over a month. The first and last sessions included audiotaped trainee SP encounters coded for effective communication behaviors. The primary outcome was change in communication scores from pre-intervention to post-intervention. We also measured trainee characteristics to identify predictors of performance and change in performance over time.ResultsWe enrolled 145 trainees who completed pre- and post-intervention SP interviews-with participation rates of 52% for physicians and 14% for nurse practitioners. Trainees' scores improved in 8 of 11 coded behaviors (p<0.05). The only significant predictors of performance were having participated in the intervention (p<0.001) and study site (p<0.003). The only predictor of improvement in performance over time was participating in the intervention (p<0.001).ConclusionsA communication skills intervention using newly trained facilitators was associated with improvement in trainees' skills in giving bad news and expressing empathy. Improvement in communication skills did not vary by trainee characteristics.

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