Pathology Resident Performance in Simulated Clinician Communication Hand-Offs
Suzanne M Dintzis, Sheila Mehri, Dan Luff, Jennie S Stuijk, Heather Mack, Greg Kotnis, Stephen S Raab. University of Washington, Seattle; University of Colorado, Denver; Cleveland Clinic, Cleveland
Background: Although errors in communication hand-offs are a major source of sentinel events, anatomic pathology residents generally receive little training in communication science. We developed and pilot-tested 15 resident-clinician communication simulation information transfer modules requiring varying levels of conflict resolution.
Design: We designed 15 intraoperative consultation, information transfer modules involving resident-clinician communication. Trained simulated clinicians communicated with residents (n = 10) through phone calls using scripted scenarios. The physicians assumed specific behaviors based on test performance metrics (e.g., turn around time, error, degree of clinical-pathologic correlation, and meaning or consequence of test results) and resident communication methods. Resident interactions were evaluated using checklists of 15-20 elements. In scenarios involving escalated physician conflict, residents received higher scores for problem solving and de-escalating behaviors. All residents had no prior training in communication science and were provided feedback after each module block. We measured resident performance based on year of training, de-escalation behaviors, and problem solving.
Results: Overall baseline resident performance ranged from 52%-85% on all modules (mean: 64%) with more senior residents receiving higher scores on basic communication checklist elements such as patient, self, and clinician identification and read-backs. All residents scored highly (range: 80%-100%) on information transfer checklist elements such as providing a diagnosis and other pathology report elements (e.g., tumor size, margin status, etc.). Residents generally performed at a lower level (e.g., 0%-60%) on some checklist items in modules involving information transfer adversity (e.g., lack of clinical-pathologic correlation) as many residents were challenged in the problem solving of potential or real errors. In resident-clinician conflict scenarios, residents exhibited high levels of empathy on checklist items (e.g., 80%-100%) and exhibited variable performance on anger de-escalation behaviors.
Conclusions: Simulated resident-clinician communication scenarios show variable performance by year of training. Residents generally perform well in straightforward information transfer and less well in clinician conflict scenarios. Augmentation of current communication resident training in areas of anger de-escalation and problem solving potentially would benefit training programs and decrease less than optimal hand-offs.
Monday, March 19, 2012 8:30 AM
Platform Session: Section H, Monday Morning