1. NYU School of Medicine CAN PROFESSIONALISM BE TAUGHT? FINALLY THERE IS EVIDENCE Department of Surgery New York University School of Medicine April 29, 2009 NYU School of Medicine Mark Hochberg, MD Adina Kalet, MD Sondra Zabar, MD Elizabeth Kachur, PhD Colleen Gillespie, PhD Russell Berman, MD

2. NYU School of Medicine NYU SCHOOL OF MEDICINE CAMPUS

3. NYU School of Medicine ACGME COMPETENCIES Patient Care Medical Knowledge Practice- Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice

4. NYU School of Medicine

5. NYU School of Medicine THE CHALLENGE Teaching and Assessing the ACGME competencies of Professionalism and Communication Skills to surgical resident learners

6. NYU School of Medicine ACGME PROFESSIONALISM & COMMUNCATION COMPETENCIES Interpersonal Skills –Info Gathering –Relationship Development –Patient Education and Counseling Ethics –Informed consent –Impaired colleague –Managing difficult situations Accountability –Admitting mistakes Altruism Sensitivity to Patients –Respect patient values –Shared decision- making –Cultural competence Respect –Interdisciplinary Respect

7. NYU School of Medicine Pre OSCE* July 2007 POST OSCE July 2008 SPICE Curriculum Six Interactive Sessions S URGICAL P ROFESSIONALISM and I NTERPERSONAL C OMMUNICATION E DUCATION (SPICE) *Objective structured clinical examination

8. NYU School of Medicine THE CURRICULUM – SIX ONE HOUR INTERACTIVE SESSIONS Advanced communication skills in surgical practice: How the pros do it Admitting mistakes: How you can become more humane Delivering bad news: Your chance to become a master surgeon Interdisciplinary respect: Working as a team Working across language and cultural barriers: Ensuring a truly informed consent Self-care of you and your family: The stress of surgical practice

9. NYU School of Medicine TEACHING METHODS Brief Mini-lecture Popular TV show video vignettes as trigger for discussion Resident team building exercises Video re-enactments of “the good, the bad and the ugly” Faculty and chief resident role modeling standardized patients VIDEO CLIPS FROM GREY’S ANATOMY

10. NYU School of Medicine Six Station OSCE 15 residents (R1s,R2s,R3s) Behaviorally anchored checklist rated by trained standardized patients –Not Done, Partly Done, Well Done –Communication: overall & three domains –Professionalism: overall & four domains Scores  % well done ASSESMENT METHODS

11. NYU School of Medicine THE OSCE SCENARIOS 1.Hernia repair – reporting wrong sided surgery to patient 2.Delivering bad news – explaining an unexpected OR death to the spouse 3.Use of an interpreter – using an interpreter to describe proposed breast operation 4.Taking a signout – identifying a resident colleague as an impaired physician 5.Patient transfer – receiving a phone request from ER to accept a patient with a venous stasis ulcer (i.e. "dump"”) 6.Health proxy – Explaining to a patient's daughter that the patient’s signed proxy supersedes daughter’s wishes

12. NYU School of Medicine EXAMPLE: DELIVERING BAD NEWS

13. NYU School of Medicine % Well Done COMPARISON OF PRE AND POST PROFESSIONALISM CURRICULUM DATA (n=15) p=0.020 p=0.011 Error bars: +/- 1 Std Dev

14. NYU School of Medicine % Well Done COMPARISON OF PRE AND POST CURRICULUM SPECIFIC COMMUNICATION DOMAINS (n=15) Error bars: +/- 1 Std Dev p=0.043 p=0.120 p=0.017

15. NYU School of Medicine COMPARISON OF PRE AND POST CURRICULUM SPECIFIC PROFESSIONALISM DOMAINS (n=15) p=0.453 p=0.021 p=0.027p=0.049 Error bars: +/- 1 Std Dev

16. NYU School of Medicine Recommend COMPARISON OF PRE AND POST CURRICULUM: STANDARDIZED PATIENT (SP) RECOMMENDATIONS (n=15) Not Highly With Reservations Recommend The error bars: +/- 1 Std Dev P<0.001

17. NYU School of Medicine CONCLUSIONS The ACGME competencies of Professionalism and Communication Skills can be positively impacted by six one-hour evidence based, interactive learning sessions This curriculum is feasible and acceptable to residents and faculty and improves patient satisfaction with their doctors

18. NYU School of Medicine NEXT STEPS Multi-institutional study to assess generalizability Hoping to recruit surgical educators at AMCs We propose to share our curriculum and assessment materials

19. NYU School of Medicine

20. NYU School of Medicine THANK YOU!

21. NYU School of Medicine Extra Slides For Questions

22. NYU School of Medicine

23. NYU School of Medicine

24. NYU School of Medicine

25. NYU School of Medicine o 15 Surgery Residents completed Pre and Post OSCEs and participated in SPICE Curriculum – 7 PGY 1s – 4 PGY 2s – 4 PGY 3s Of 24 Total Residents

26. NYU School of Medicine OSCE Scores # Items (# Cases) Cronbach’ s Alpha Communication11 items (6 cases).65 Information Gathering3 items (6 cases).62 Relationship Development5 items (6 cases).72 Patient Education and Counseling3 items (6 Cases).62 Professionalism53 items (6 cases).62 Accountability10 items (3 cases).61 Giving Bad News7 items (2 cases).58 Working with an Interpreter5 items (1 case).55 Being Sensitive to Patient15 items (5 cases).60

27. NYU School of Medicine Interpersonal and Communication Skills –Information Gathering –Relationship Development –Patient Education and Counseling Professionalism –Accountability –Interdisciplinary Respect –Managing Difficult Situations Giving Bad News Responding to Emotions –Being Sensitive to Patient Working with an Interpreter Respect Patient Values Shared Decision-Making

28. NYU School of Medicine Teaching Principles OSCEs are the perfect tool Administered in July and again in June to R1, R2 and R3 learners Have been repeatedly validated as an assessment tool Great care taken to write realistic scenarios and scrupulously train the actors Actors given detailed grading sheets for the differing scenarios to assess if learners tasks were “well done”, “partially done” or “not done”

29. NYU School of Medicine o 8 residents completed the post-test OSCE but NOT the pre-test (but did participate in SPICE) – Allowing for an estimate of effect of pre-test

30. NYU School of Medicine

31. NYU School of Medicine CONCLUSIONS Through the use of an interactive curriculum, standardized patients and the OSCE, we have shown that the ACGME core competencies of Professionalism and Communication Skills can be effectively taught to surgical resident learners – and can positively effect their patient interactions