Communication with Patients & Families
We conclude our focus on communication skills with a discussion about communication with patients and their families. In terms of assessing and providing feedback on this skillset, you have two major strategies to choose from, each with its own set of strengths and weaknesses:
The first and most obvious is direct observation, which allows you to get a first-hand look at how the learner’s interaction with the patient and his or her family went. When directly observing for communication skills, look for the following:
Nonverbal communication, both on the part of the trainee and the patient/family. Did the trainee send unintentional nonverbal cues? Did they pick up on cues from the patient and family members?
Introduction of any visitors and inclusion of their concerns in the conversation.
Setting of expectations regarding management, workup and likely outcome(s) of ED visit.
Utilization of de-escalation techniques as needed.
Direct observation is obviously associated with a Hawthorne effect; your presence will affect the conversation, potentially creating a sense of artificiality. When providing feedback, reinforce the importance of positive behaviors you observed and make suggestions for alternative ways to navigate similar conversations in the future.
The alternative to direct observation is allowing the trainee to see the patient on his or her own. This provides a greater sense of ownership and authenticity and more closely resembles the conversations the trainee is likely to have later in their career. However, it requires you to use alternative means of assessment. These can include:
Asking the resident. Were there parts of the conversation that went well? Times when they struggled? Are they able to tell you what the patient’s goal for the visit is? What expectations did they set? Did they follow up to review the results of the workup and discharge instructions?
Asking another staff member, such as a nurse, tech, or scribe. Their perspectives can be especially useful when debriefing difficult encounters. This can sometimes be interpreted as adversarial by trainees. One option is to have residents ask these people for perspectives or feedback once it’s clear the conversation didn’t go well.
Asking the patient and family. Did they feel like they were listened to, taken seriously, and communicated with?
How well we’re able to communicate with patients, families, consultants, and each other is a major driver of satisfaction at the end of the shift. Set trainees up for success and career longevity by helping them refine this skillset.
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Kessler CS, et al. The 5Cs of Consultation: Training Medical Students to Communicate Effectively in the Emergency Department. Journal of Emergency Medicine 2015;49(5):713–21.