1. Communication Skills for Neurosurgeons: Neurosurgery Boot Camp 2 Michael M. Haglund MD, PhD, FCS (ECSA) Distinguished Professor of Neurosurgery, Neurobiology, & Global Health Program and Training Director, Duke Neurosurgery Co-Director Uganda Neurosurgery Training Program Surgical Director, Duke Epilepsy Center and Neil Prose MD Professor of Pediatrics and Dermatology Duke University Health System Durham, North Carolina Supported by a Dr. Dzau Duke GME Innovation Grant Duke University Medical Center Durham, North Carolina, USA

2. Communication Skills for Surgeons “The single biggest problem with communication is the illusion it has taken place” George Bernard Shaw

3. Communication Skills for Neurosurgeons National Survey of NSU Program Directors (response rate: 92%) Skill in Communication Milestones

4. Communication Skills for Neurosurgeons 8 of 23 fully or partially covered

5. Communication Skills for Surgeons Bad scenario Delivering Bad News: Look for three things Dr. Anderson could have done better:

6. Communication Skills for Surgeons Good scenario Delivering Bad News: Of the three things you listed, check off if Dr. Anderson did them

7. Communication Skills for Neurosurgeons Delivering Bad News: 1. Sit down 2. start with an Open ended question 3. Listen 4. Say back what you heard pneumonic: SOLS 5. Fire a “warning shot” and give news in a direct way 6. Allow them to absorb information 7. Ask permission to proceed 8. Explain in clear language 9. Offer support 10. “What questions do you have?”

8. Communication Skills for Neurosurgeons Duke Neurosurgery Residents (14/17) Pilot Study November 2012, Two hour session, Five videos

9. Communication Skills for Neurosurgeons Pilot Study: Duke Neurosurgery Residents (15/17) November 2012, Two hour session, Five videos

10. Communication Skills for Neurosurgeons Taking a History : Look for three things Dr. Anderson could have done better: Bad scenario

11. Communication Skills for Neurosurgeons Taking a History : Of the three things you listed, check off if Dr. Anderson did them Good scenario

12. Communication Skills for Neurosurgeons Taking a History: 1. Sit down 2. start with an Open ended question 3. Listen 4. Say back what you heard 5. Explain the plan in clear language 6. Offer support 7. “What questions do you have?”

13. Communication Skills for Neurosurgeons Getting Informed Consent: Look for three things Dr. Anderson could have done better: Bad scenario

14. Communication Skills for Neurosurgeons Getting Informed Consent: Of the three things you listed, check off if Dr. Anderson did them Good scenario

15. Communication Skills for Neurosurgeons Obtaining Informed Consent: 1. Sit down 2. Start with an Open ended question 3. Listen 4. Say back what you heard 5. Explain the plan in clear language 6. Offer support 7. “What questions do you have?”

16. Communication Skills for Neurosurgeons Delivering a Disappointing Outcome: Look for three things Dr. Anderson could have done better: Bad scenario

17. Communication Skills for Neurosurgeons Delivering a Disappointing Outcome: Of the three things you listed, check off if Dr. Anderson did them Good scenario

18. Communication Skills for Neurosurgeons Delivering a Disappointing Outcome: 1. Sit down 2. Fire a “warning shot” and give news in a direct way 3. Allow patient to absorb information 4. Ask permission to proceed 5. Apologize when appropriate 6. Explain the result in clear language 7. Recognize emotions 8. Offer hope and reassurance 9. “What questions do you have?”

19. Communication Skills for Neurosurgeons Summary: Taking History and Informed Consent 1. Sit down 2. Start with an Open ended question 3. Listen 4. Say back what you heard SOLS 5. Explain the plan in clear language 6. Offer support 7. “What questions do you have?”

20. Communication Skills for Neurosurgeons Summary: Delivering Bad News or a Disappointing Outcome: 1. Sit down 2. Start with an open question 3. Listen 4. Say back what you heard 5. Fire a “warning shot” and give news in a direct way 6. Allow them to absorb information 7. Ask permission to proceed 8. Apologize when appropriate (disappointing outcome) 9. Explain in clear language 10. Offer support 11. “What questions do you have?”