Dear Education SIG Colleagues,

Over the years, many of you have likely become familiar with or participated in Oncotalk and similar courses (e.g. Geritalk, Critical Care Communication Course, Nephrotalk) aimed at improving communication skills of trainees. Through palliative care fellowship and early career development, I felt like I had developed the target communication skills of these courses. However, as an educator, I struggled to pass these skills on to trainees, relying mostly on modeling and discussion. I have yearned to develop a more robust repertoire for teaching communication skills.

IntensiveTalk was a program which fulfilled these faculty development goals for me. Through IntensiveTalk, I developed a deeper understanding of the use of small group teaching and simulation to teach communication skills. IntensiveTalk was led by a group of expert palliative care communication educators/investigators through VitalTalk (http://vitaltalk.blogspot.com/) who also recently directed a similar faculty development program, Pallitalk. Since there will likely be similar faculty development programs in the future, I thought it would be helpful to share some information about the IntensiveTalk Course.

The IntensiveTalk course was comprised of 2 three day retreats in Pittsburgh. Ten different institutions were represented, with each institution sending a palliative care faculty member along with a critical care faculty colleague. Before the course, I was curious about how this mix of palliative care and critical care faculty would work. How would the investigators make sure that everyone was on the same page about the target communication skill-set? Would there be noticeable differences between the two specialties which would interfere with development of the teaching skills? This concern quickly became negligible, and I think the structure of the first retreat largely played a role in this:

     1. Day 1: Through a combination of large group and small group sessions, faculty participants learned about target communication skills for giving serious news and redefining goals of care. The two small groups were each an equal blend of palliative care and critical care faculty. In the small group sessions, faculty participants took part in simulated family meetings with trained actors. These sessions served as a way to ensure that each faculty participant understood the target communication skills, gave participants an introduction to the teaching method, and also provided a sense of what it’s like for learners to take part in the teaching method (e.g. what it’s like to be in the “hot seat” talking to a simulated patient or family).

     2. Day 2: On this day, the focus pivoted towards the skills necessary for facilitating the simulations from day 1. The “learner hot seat” was now inhabited by a “simulated fellow” and the participants now took their place in the “hot seat” as a facilitator. The investigators provided a facilitation roadmap, and each participant was given opportunities to practice key steps in the roadmap (such as helping learners to set goals, how to use time-outs to effectively debrief, and eliciting take-home points from learners). To further emphasize the importance of the facilitation roadmap, the investigators continued to use this roadmap to facilitate participants as they learned the roadmap and target facilitation skills!

     3. Day 3: This day offered further opportunities to practice facilitation followed by a session for each institutional dyad to consider their plans for developing educational sessions at home.

In between retreats, there were frequent emails amongst group participants, allowing a chance for each dyad to share their successes and challenges as well as obtain feedback.

The second retreat offered opportunities to consolidate facilitation skills, learn about small group teaching dynamics, and more helpful sessions on developing simulation courses.

     1. Day 1: In addition to offering further opportunities to practice small group facilitation skills, this day offered an opportunity to do brief drills which isolated common challenges which learners might present (e.g. the learner who has difficulty identifying a learning goal, the anxious learner, the skeptical learner, etc).
     2. Day 2: More small group practice on small group dynamics issues (e.g. when learners are disruptive, etc). There were also sessions focused on course development (e.g. eliciting support from your institution, budgeting, etc).
     3. Day 3: This day focused on actor training, including an opportunity to practice training an actor for a new simulation.

Interspersed throughout the course were sessions which focused on educational theory, time for reflection on professional goals (as both a clinician and educator) and community development. By the end of the first retreat, it felt like we were part of a cohesive community, and distinctions between palliative care and critical care dissolved.

Because of the extent of non-ideal communication I observe on a daily basis in my practice setting, this has frequently resulted in a desire to prompt a sea change in practices. An “a-ha” moment for me as a participant was when I realized that this sea change cannot and will not come instantly under any circumstance. Sea change comes through identification of a personal “learning edge” and making one small change at a time (akin to continuous quality improvement). In addition, amidst the miscommunication, we need to provide ample positive feedback for things which learners already do well.

The teaching methods I learned through this course have already helped me better teach communication skills at my institution. The course played a significant role in the development of a local three day course for critical care fellows, led by my critical care colleague and me.

A nonprofit with the mission of nurturing healthier connections between patients and clinicians, VitalTalk continues to look for opportunities to provide similar faculty development programs for educators. Keep your eyes peeled for similar opportunities! You can sign up for email notifications from VitalTalk and follow them on Twitter (see their website: http://vitaltalk.blogspot.com/ ). Feel free to contact me with questions about IntensiveTalk.

For more information on the teaching methods, see Fryer-Edwards, K., et al. (2006). “Reflective teaching practices: an approach to teaching communication skills in a small-group setting.” Academic Medicine 81(7): 638-644.

Cheers,
Lyle Fettig, M.D.
Assistant Professor of Clinical Medicine
Indiana University School of Medicine
1001 W. Tenth St. OPW M200
Indianapolis, IN 46202
Pager- (317) 310-7988
Phone- (317) 630-7061
lyfettig@iupui.edu