Communication is an essential skill for the internist. Whether we are communicating with our patients and their caregivers, our colleagues, or the public, clear communication is paramount. Communication takes many forms – verbal, non-verbal, written, and electronic. We offer the educational activities to help our residents develop outstanding communication skills. We have developed Direct Observation Tools (“DOTs”) that residents can use to get direct, in-the-moment feedback for specific communication skills and scenarios.
Brief Action Planning OSCE
During PGY1-year, interns participate in a communication workshop where they learn how to use motivational interviewing and brief action planning skills to promote behavior change amongst their patients. Through role play and patient simulation, interns learn how to assess a patient’s level of readiness to change, identify change talk, and use reflective listening to create a tailored care plan with their patient.
Goals of Care
Each of our PGY1s rotates with the Palliative Care Service over the course of their intern year. Interns learn how to discuss goals of care, discuss prognosis, deliver bad news, and facilitate family meetings.
Center to Advance Palliative Care (CAPC)
Residents complete asynchronous learning using the CAPC modules which cover communication skills and skill-building in basic advance care planning.
Telehealth
During their 3-years of training, residents learn how to use telehealth in their daily clinical practice. Since the start of the COVID19 pandemic, residents regularly perform video and phone call telehealth visits in the outpatient setting and are able to provide remote monitoring services for their patients. Our program has also spearheaded a primary care telehealth curriculum, which was published in the Journal of Graduate Medical Education:
Wong R, Ng P, Spinnato T, Taub E, Kaushal A, Lerman M, Fernan A, Dainer E, Noel K. Expanding Telehealth Competencies in Primary Care: A Longitudinal Interdisciplinary Simulation to Train Internal Medicine Residents in Complex Patient Care. J Grad Med Educ. 2020 Dec;12(6):745-752. doi: 10.4300/JGME-D-20-00030.1. Epub 2020 Dec 4. PMID: 33391599; PMCID: PMC7771597.
Documentation
Annually our residents participate in workshops to help improve their ability to effectively document their clinical reasoning and care plans. Our workshops cover the way that documentation impacts a legal suit, the use of a framework to concisely summarize patient encounters, and strategies to avoid stigmatizing language in the EMR.
Safe Hand-offs
We pride our effort to conduct effective communication during hand-offs, or what is typically referred to as “sign-outs” from one caregiver to another during shift-to-shift transfer. Our residents use the IPASS framework for standardized hand-offs. IPASS is an evidenced-based tool that has been shown to decrease the number of medical errors related to communication. When we communicate using a shared framework, fewer errors occur.
Fryman C, Hamo C, Raghavan S, Goolsarran N. A Quality Improvement Approach to Standardization and Sustainability of the Hand-off Process. BMJ Qual Improv Rep. 2017;6(1):u222156.w8291. Published 2017 Apr 6.
All medicine residents are expected to use IPASS as the preferred method of standardized hand-off during all patient encounters. Our residents conduct IPASS hand-off verbally and electronically (in the EMR) with each other during shift changes. The IPASS hand-off is updated by the transmitter with confirmation by the receiver at shift changes.
|
IPASS Mnemonic |
Description |
Benefits/Highlights |
|
Illness Severity |
Identification as stable, “watcher”, or unstable |
Allows rapid identification of sick patients in the EMR |
|
Patient Summary |
Summary statement, events leading up to admission, hospital course, ongoing assessment |
Snapshot view of a patient’s story and hospital course |
|
Action List |
To do list and timeline |
Clear instructions for what to do and track for each patient |
|
Situation Awareness/ Contingency Planning |
Know what’s going on; plan for what might happen (anticipatory guidance) |
Helps residents plan for the worst. Serves as a guide for the do’s and don’ts for each patient |
|
Synthesis by Receiver |
Receiver to summarize what was heard during verbal handoff |
Form of closed loop communication that ensures that the information received is accurate |
Calling a Consultation
As the “doctor’s doctor”, the internist is relied upon to provide consultation to a range of medical services. PGY1s participate in our “Call the Consultant” workshop in which they learn a framework (P-CONSULT) for requesting consultation and then practice this skill using case scenarios. The workshop also reviews best practices for performing consultation as an internist.
