Communication in the heat of
battle
Victoria Brazil
Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a b...
Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a b...
Communication is our most
important clinical skill
•
•
•
•
•

•

Most frequently performed
Greatest diagnostic utility
Sav...
Your day…….
36.5 communication events per hour
A third of communication events are interruptions
10% are concurrent conver...
Your consultation
You saving lives
•

Urgently

•

Not so urgently
Your patients’ safety..
Your best medicolegal defence
Your happiness at the end of
the day……..
Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a b...
Teamwork and leadership
Crisis resource Management
(CRM)
•
•
•
•
•
•

Know your environment
Call for help early
Take a leadership role
Communicate...
Crisis resource Management
(CRM)
•
•
•
•
•
•

Know your environment
Call for help early
Take a leadership role
Communicate...
Training for CRM
Handovers
Interprofessional communication
Tribes are big in healthcare….
Cross cultural communication
Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a b...
Simulation anyone..?
Communication skills
for “early learners”
“Hello my name is……..”
“Training in
communication skills
does not necessarily lead to
skilled communication”
BEME Guide no 2: Teaching and Learni...
Gender matters
Getting more from our
SPs…..?
( Vic sees the light after
8 years of mannequin
sim……!)
Patient care interaction with
heightened arousal
More confederates…
SPs and ‘patient voice’
“There have been times if I am playing the
role of a woman from the lower echelons of
society, tha...
“I have played the role of a pregnant mother
who has been told her unborn baby has Down
Syndrome. ..
In this situation I h...
SPs and Cultural issues

‘I just can’t do this [shaking head]’
—female medical student refuses to apply
ECG electrodes to ...
‘Crossing Boundaries’
“The Standardized Patient Instructor has an
essential role in preparing and training medical
student...
………..Triggering the conflict opens the
door to learning opportunities and bridge
building;
……that is, the creation of acce...
Lets think about some
simulated patient educators
for postgraduate training?
Handovers
•

•

SBAR, isoBAR…….

Training needs to be customised, and
recognise context…..hierarchies, tribalism
and more
Simulating patient journeys
Med student …..
“When the doctor isn’t there - who looks
after the patients…?”
Simulating patient journeys
-communication for advanced
practitioners
“STEMI-sim”
•

Using sim to improve the care of real...
CL prep
Most valuable aspects?
•

•

“The debrief as an entire group, was the most
valuable part of this exercise. I felt it gave ...
Results – STEMI patient data
•

Baseline (july –Dec 2010)
–

•

Post ‘stemi-sim’ ( July – Dec 2011)
–

•

Median ‘Door to ...
Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a b...
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
Victoria Brazil: Communication in the Heat of Battle
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Victoria Brazil: Communication in the Heat of Battle

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Brazil illustrates the depth of communication required in medical practice between people within health care delivery systems.

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Victoria Brazil: Communication in the Heat of Battle

  1. 1. Communication in the heat of battle Victoria Brazil
  2. 2. Communication is our most important clinical skill There are some specific challenges in critical care Training helps……a bit
  3. 3. Communication is our most important clinical skill There are some specific challenges in critical care Training helps……a bit
  4. 4. Communication is our most important clinical skill • • • • • • Most frequently performed Greatest diagnostic utility Saves lives Best medicolegal defence Most frequent problems if poorly performed Best skill to keep you happy at the end of the day
  5. 5. Your day……. 36.5 communication events per hour A third of communication events are interruptions 10% are concurrent conversations Coiera etc al Med J Aust 2002; 176 (9): 415-418.
  6. 6. Your consultation
  7. 7. You saving lives • Urgently • Not so urgently
  8. 8. Your patients’ safety..
  9. 9. Your best medicolegal defence
  10. 10. Your happiness at the end of the day……..
  11. 11. Communication is our most important clinical skill There are some specific challenges in critical care Training helps……a bit…..
  12. 12. Teamwork and leadership
  13. 13. Crisis resource Management (CRM) • • • • • • Know your environment Call for help early Take a leadership role Communicate effectively Maintain situational awareness Distribute the workload
  14. 14. Crisis resource Management (CRM) • • • • • • Know your environment Call for help early Take a leadership role Communicate effectively Maintain situational awareness Distribute the workload
  15. 15. Training for CRM
  16. 16. Handovers
  17. 17. Interprofessional communication
  18. 18. Tribes are big in healthcare….
  19. 19. Cross cultural communication
  20. 20. Communication is our most important clinical skill There are some specific challenges in critical care Training helps……a bit
  21. 21. Simulation anyone..?
  22. 22. Communication skills for “early learners”
  23. 23. “Hello my name is……..”
  24. 24. “Training in communication skills does not necessarily lead to skilled communication” BEME Guide no 2: Teaching and Learning communication skills in medicine. Medical Teacher 1999
  25. 25. Gender matters
  26. 26. Getting more from our SPs…..? ( Vic sees the light after 8 years of mannequin sim……!)
  27. 27. Patient care interaction with heightened arousal
  28. 28. More confederates…
  29. 29. SPs and ‘patient voice’ “There have been times if I am playing the role of a woman from the lower echelons of society, that I have actually felt the student’s disdain for me as a person. … …..Perhaps the student did not realise he was showing disdain.”
  30. 30. “I have played the role of a pregnant mother who has been told her unborn baby has Down Syndrome. .. In this situation I have been met with many varied responses… From nervous laughter, to distracted looks, to a complete lack of empathy……. I really feel the pain of that pregnant mother. ………I am physically crying and totally distraught. ……………. And if the responses to this situation are not right, I will tell the student exactly what is lacking, which is so often sensibility.”
  31. 31. SPs and Cultural issues ‘I just can’t do this [shaking head]’ —female medical student refuses to apply ECG electrodes to male SP Instructor
  32. 32. ‘Crossing Boundaries’ “The Standardized Patient Instructor has an essential role in preparing and training medical students to break through that barrier. ………….the SP has a dual role of patient advocate and student educator, ……..requires deep sensitivity, psychological awareness, sociocultural knowledge and a commitment far beyond passive participation……. ……. Medical students need clinical scenarios that trigger conflict between the accepted notion of duty of care and personal socio-cultural values……….
  33. 33. ………..Triggering the conflict opens the door to learning opportunities and bridge building; ……that is, the creation of acceptable compromises that will preserve the integrity of personal beliefs and values while upholding foundational bioethical and legal principles……...”
  34. 34. Lets think about some simulated patient educators for postgraduate training?
  35. 35. Handovers • • SBAR, isoBAR……. Training needs to be customised, and recognise context…..hierarchies, tribalism and more
  36. 36. Simulating patient journeys Med student ….. “When the doctor isn’t there - who looks after the patients…?”
  37. 37. Simulating patient journeys -communication for advanced practitioners “STEMI-sim” • Using sim to improve the care of real patients with STEMI at our institution
  38. 38. CL prep
  39. 39. Most valuable aspects? • • “The debrief as an entire group, was the most valuable part of this exercise. I felt it gave an opportunity to identify and discuss the entire process, (STEMI Patient), with other personnel that normally we would only interact with, in passing. “ “Being able to 'stand back' and observe the process, allowing identification of potential areas of delay and ideas for improvement ‘
  40. 40. Results – STEMI patient data • Baseline (july –Dec 2010) – • Post ‘stemi-sim’ ( July – Dec 2011) – • Median ‘Door to lab’ 60 mins (n= 35) Median ‘Door to lab’ 27 mins (n= 22) p = 0.003
  41. 41. Communication is our most important clinical skill There are some specific challenges in critical care Training helps……a bit

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