This document provides a final report on a project to develop and evaluate an emergency medicine resident training curriculum focused on interpersonal and professionalism skills. The project aimed to:
1) Design, implement, and evaluate a patient-centered healthcare curriculum for 60 emergency medicine residents.
2) Evaluate the predictive validity of objective structured clinical examinations (OSCEs) by assessing resident performance on OSCEs and in actual patient care.
3) Disseminate the patient-centered care educational program to other emergency medicine programs.
The project was conducted in four phases: establishing a baseline with OSCEs, developing and implementing interactive workshop curriculum, conducting post-curriculum OSCEs, and piloting un
The TAP project is developing a program at UCSF to facilitate the transition of adolescent patients with chronic health needs from pediatric to adult care. This includes resident training in transitional care competencies and a transition handbook for patients to teach self-management skills.
The IPR project at the Medical College of Georgia will initiate patient- and family-centered rounds on adult medical and surgical units, initially evaluating one team for satisfaction, costs, efficiency and quality/safety.
The Resident Performance project at Carilion Clinic intends to adapt an evaluation tool for patients to assess resident performance on ACGME competencies, comparing feedback and coaching to attending-only feedback.
This document provides an overview of the Med-Peds specialty, which involves training and practice in both internal medicine and pediatrics. It discusses the history and development of Med-Peds programs, the residency and training process, practice options, growth potential, and salaries for Med-Peds physicians. The document also examines reasons for choosing Med-Peds and provides results from an O-Net profiler assessment of the author's investigative and social skills that relate to this specialty.
Harvard style research paper nursing evidenced based practiceCustomEssayOrder
This document discusses evidence-based practice in health and social care. It defines evidence-based practice as using the best available research evidence to guide decisions about patient care and service delivery. The document outlines how evidence-based practice helps improve patient outcomes and keep practices current. It also examines how social care providers are expected to demonstrate the effectiveness and accountability of their services.
Course 2 the need for a careful and thorough historyNelson Hendler
The medical literature reports that 40%-80% of chronic pain patients are misdiagnosed. Clearly, misdiagnosis leads to ordering the wrong tests, and thereby obtaining an incorrect diagnosis, or overlooking a diagnosis totally, which results in mistreatment. Many reports in the medical literature indicate the best way to get an accurate diagnosis, is to obtain a complete and thorough history. However, this is a time consuming process, and most physicians don’t spend the needed time with a patient. Therefore, a team of doctors from Johns Hopkins Hospital developed a 72 question test, with 2008 possible answers, available over the Internet. When a patient completes the questionnaire, diagnoses are returned within 5 minutes. These diagnoses have a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This is the highest level of accuracy of any expert system available. The efficacy of this approach is proven by outcome studies, which prove that this approach results in a far higher return to work rate and reduced use of medication and doctors visits, when compared to other techniques. This is similar to the techniques used by Johns Hopkins Hospital to reduce their workers compensation payments by 54%.
This document provides an overview of the Med-Peds specialty, which involves training and practice in both internal medicine and pediatrics. It discusses the history and development of Med-Peds programs in the 1960s in response to the primary care movement. The document outlines the 4-year residency training requirements, including rotations in adult/pediatric medicine, intensive care, and various subspecialties. It also explores practice options for Med-Peds physicians and reasons for choosing this specialty, including working with patients across the lifespan and career flexibility. Potential graduate programs in South Carolina are described.
This document discusses evidence-based practice (EBP) and provides context around its definition and applications. It notes that while EBP aims to integrate the best research evidence with clinical expertise and patient values, there are limitations in how it is sometimes implemented in healthcare policy and funding decisions. The document also explores debates around EBP and argues that it should not be the only approach to evaluating evidence, as other types of research also provide valuable knowledge for practice.
This document provides biographical and professional information about Susan Marie Perry. It summarizes her educational and professional background, including obtaining a PhD in Nursing Science from Uniformed Services University in 2012. It also outlines her over 25 years of experience as a Certified Registered Nurse Anesthetist in the U.S. Air Force Nurse Corps before retiring at the rank of Colonel. Currently, she is the Senior Assistant Dean and Director of the Certified Registered Nurse Anesthesia Program at the University of South Florida College of Nursing.
The TAP project is developing a program at UCSF to facilitate the transition of adolescent patients with chronic health needs from pediatric to adult care. This includes resident training in transitional care competencies and a transition handbook for patients to teach self-management skills.
The IPR project at the Medical College of Georgia will initiate patient- and family-centered rounds on adult medical and surgical units, initially evaluating one team for satisfaction, costs, efficiency and quality/safety.
The Resident Performance project at Carilion Clinic intends to adapt an evaluation tool for patients to assess resident performance on ACGME competencies, comparing feedback and coaching to attending-only feedback.
This document provides an overview of the Med-Peds specialty, which involves training and practice in both internal medicine and pediatrics. It discusses the history and development of Med-Peds programs, the residency and training process, practice options, growth potential, and salaries for Med-Peds physicians. The document also examines reasons for choosing Med-Peds and provides results from an O-Net profiler assessment of the author's investigative and social skills that relate to this specialty.
Harvard style research paper nursing evidenced based practiceCustomEssayOrder
This document discusses evidence-based practice in health and social care. It defines evidence-based practice as using the best available research evidence to guide decisions about patient care and service delivery. The document outlines how evidence-based practice helps improve patient outcomes and keep practices current. It also examines how social care providers are expected to demonstrate the effectiveness and accountability of their services.
Course 2 the need for a careful and thorough historyNelson Hendler
The medical literature reports that 40%-80% of chronic pain patients are misdiagnosed. Clearly, misdiagnosis leads to ordering the wrong tests, and thereby obtaining an incorrect diagnosis, or overlooking a diagnosis totally, which results in mistreatment. Many reports in the medical literature indicate the best way to get an accurate diagnosis, is to obtain a complete and thorough history. However, this is a time consuming process, and most physicians don’t spend the needed time with a patient. Therefore, a team of doctors from Johns Hopkins Hospital developed a 72 question test, with 2008 possible answers, available over the Internet. When a patient completes the questionnaire, diagnoses are returned within 5 minutes. These diagnoses have a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This is the highest level of accuracy of any expert system available. The efficacy of this approach is proven by outcome studies, which prove that this approach results in a far higher return to work rate and reduced use of medication and doctors visits, when compared to other techniques. This is similar to the techniques used by Johns Hopkins Hospital to reduce their workers compensation payments by 54%.
This document provides an overview of the Med-Peds specialty, which involves training and practice in both internal medicine and pediatrics. It discusses the history and development of Med-Peds programs in the 1960s in response to the primary care movement. The document outlines the 4-year residency training requirements, including rotations in adult/pediatric medicine, intensive care, and various subspecialties. It also explores practice options for Med-Peds physicians and reasons for choosing this specialty, including working with patients across the lifespan and career flexibility. Potential graduate programs in South Carolina are described.
This document discusses evidence-based practice (EBP) and provides context around its definition and applications. It notes that while EBP aims to integrate the best research evidence with clinical expertise and patient values, there are limitations in how it is sometimes implemented in healthcare policy and funding decisions. The document also explores debates around EBP and argues that it should not be the only approach to evaluating evidence, as other types of research also provide valuable knowledge for practice.
This document provides biographical and professional information about Susan Marie Perry. It summarizes her educational and professional background, including obtaining a PhD in Nursing Science from Uniformed Services University in 2012. It also outlines her over 25 years of experience as a Certified Registered Nurse Anesthetist in the U.S. Air Force Nurse Corps before retiring at the rank of Colonel. Currently, she is the Senior Assistant Dean and Director of the Certified Registered Nurse Anesthesia Program at the University of South Florida College of Nursing.
Scott W. Baumgartner is a rheumatologist and clinical researcher with extensive experience leading clinical trials and medical affairs functions at pharmaceutical companies. He has held roles such as Vice President of Medical Affairs and Clinical Research & Development at Ardea Biosciences and Amgen, where he oversaw global clinical development programs and medical evidence generation activities. Currently, he works as an independent consultant providing advice to pharmaceutical companies on various healthcare issues.
Dr Pradeep Jain Fortis Hospital - CURRICULUM VITAE. Dr Pradeep Jain Fortis Hospital has the widest spectrum of advanced Laparoscopic Surgery in GI Surgery field.
This document lists over 70 potential topics for nursing research projects related to medical/surgical nursing. The topics cover a wide range of clinical areas and patient populations, and focus on assessing the effectiveness of various nursing interventions like education programs, relaxation techniques, yoga, and more. Many of the proposed studies would take place in selected hospitals in Mehasana, India.
Marly Jiby is a registered nurse seeking a position in medical surgical, telemetry, or psychiatric nursing. She has over 15 years of nursing experience in medical surgical, emergency room, and intensive care settings in both the United States and India. Her experience includes providing direct patient care, monitoring conditions, collaborating with healthcare teams, and maintaining compliance with policies and procedures. She has certifications in medical surgical nursing, ACLS, and BCLS.
This document outlines a study conducted by Anjalatchi to assess the knowledge of staff nurses regarding prevention and management of perineal tears during normal delivery. The study was conducted at selected hospitals in Lucknow, India between 2019-2021. A questionnaire was developed and administered to 250 staff nurses to collect data on their knowledge. The results found that the majority of nurses had average knowledge, while some had poor or good knowledge. Overall knowledge was higher regarding management of tears compared to prevention. The study aims to identify gaps in nurse knowledge to help develop an educational module for improving care of mothers during childbirth.
The document provides guidelines for conducting research on health disaster response. An international panel of experts developed a consensus on research priorities and a mixed-methods approach. The priorities include assessing community preparedness before a disaster and evaluating the response and health impacts after. A mixed-methods approach using both qualitative and quantitative data is recommended to improve the quality of evidence-based research on disaster medicine.
HRSA Comprehensive Geriatric Education Grant Posternomadicnurse
This grant funds a Clinical Nurse Specialist position to work with current Gerontological CNS in providing education, mentoring / support, developing / measuring outcomes for knowledge, practice change and patient outcomes by:
Expanding NICHE training at Piedmont Hospital in Atlanta beyond Acute Care nurses to include Emergency Department nurses;
2) Introducing NICHE training at Piedmont Fayette, Piedmont Newnan and Piedmont Mountainside for Acute Care and Emergency Department nurses;
3) Introducing NICHE training for nursing staff at two of our Long-Term Care facility partners; and
4) Disseminating program materials and information to other healthcare entities throughout Georgia and the U.S. through local workshops and presentations at national healthcare conferences.
This study assessed patients' attitudes regarding nursing students' involvement in their care at BPKIHS. Most patients reported positive attitudes. Specifically:
- Over 90% felt glad about student nurses' presence, believed they can ask questions, and liked how student nurses examine them in detail.
- Over 50% felt student nurses devote more time, help in treatment, and examine thoroughly.
- Over 80% believed student nurses have disease knowledge and good behavior.
However, some patients felt student nurses could improve by developing more helping attitudes, treating all patients equally, and counseling patients and families. Overall, most patients welcomed student nurses' involvement and perceived educational benefits.
This research proposal outlines a quantitative study that aims to investigate nurses' attitudes, knowledge, and experiences in prioritizing comfort measures for dying patients in an acute hospital setting. A literature review identified key themes in end-of-life care including identifying the dying phase, providing comfort care, and managing symptoms. Several studies found that nurses and doctors differed in their approaches, with nurses more focused on comfort and doctors on cure, hindering optimal end-of-life care. The proposal will survey 200 nurses using questionnaires to assess their perspectives on comfort care for the dying. The goal is to identify needed interventions through education, training, and management to improve end-of-life care for patients in Irish hospitals.
- Evidence-based practice (EBP) involves integrating the best research evidence, clinical expertise, and patient values and needs.
- EBP follows steps including asking questions, locating evidence, critically appraising evidence, integrating the information, and evaluating outcomes.
- Nursing research is important for EBP as it provides empirical knowledge through describing phenomena, explaining relationships, predicting outcomes, and enabling control of situations by testing interventions.
This study evaluated time-to-event analytic methods for health economic evaluation. It discussed challenges in estimating accurate transition probabilities in the presence of competing risks, recurrent events, and time-varying factors. It reviewed the state of the science for time-to-event analysis in cost-effectiveness analysis and described three techniques - multi-state Markov models, frailty models, and marginal structural models - to address methodological challenges posed by time-to-event data. The study concluded by calling for continued methodological development in time-to-event analytic methods to better address issues like competing risks, recurrent events, and time-dependent exposures in health economic modeling.
Overview and Future of Nursing ResearchEnoch Snowden
Nursing research has evolved significantly over time. It began with Florence Nightingale's work but gained more prominence in the 20th century. Several important developments have occurred in India as well, including establishing research societies and increasing PhD programs. Looking ahead, nursing research is expected to focus more on evidence-based practices, systematic reviews, and interdisciplinary collaboration to continue improving patient outcomes.
Improving End-of-life Care in the Emergency DepartmentMichael Gisondi
Grand Rounds lecture presented at Palmetto Health Richland Emergency Medicine Residency Program / University of South Carolina School of Medicine, August 2016. Reviews the concept of Primary Palliative Care in the ED and the research efforts of The EPEC-EM Project: Education in Palliative and End-of-Life Care in Emergency Medicine.
The document discusses a PICOT project focused on enhancing pain management through nurse education. It aims to reduce hospitalization rates by providing more frequent educational opportunities for nurses to improve patient outcomes. The training will target technology-based pain management and communication approaches. A literature review found that organizational leadership, adequate staffing and resources are key to effective pain management. Barriers like gaps in education and communication must be addressed. The project will use Lewin's change model and a knowledge-to-action framework to provide topic-specific education, assess gaps, collect data, and support continuous learning to improve clinical practices long-term. The goal is a 5% reduction in cancer-related hospitalizations in the local area.
The document discusses the history and development of nursing research from its origins in the 1850s led by Florence Nightingale to current priorities and trends. Some key events include the establishment of the first nursing research organization Sigma Theta Tau in 1936, increased government funding of nursing research beginning in the 1940s-1950s, and the establishment of the National Institute of Nursing Research in 1993 which significantly advanced the field. The document outlines priority areas for nursing research according to different specialties such as clinical nursing, nursing administration, and nursing education.
This review of literature summarizes several studies related to perineal tears during childbirth. Some key findings include:
1) Studies found higher rates of anal incontinence and impaired pelvic floor structures in women who experienced undiagnosed or missed perineal tears compared to diagnosed tears.
2) Techniques like warm compresses, perineal massage, and hands-off positioning were found to reduce rates of severe perineal tearing in some studies.
3) Operative vaginal deliveries and midline episiotomies were associated with higher risks of anal sphincter injuries and severe perineal trauma in several studies.
4) Implementation of checklists and
A document prepared by Dr. Mustafa Salih, the former director of the Directorate General of Health Policy, planning and research at the Federal ministry of Health in Sudan.
This document provides an introduction to a review article about the clinical approach to diagnosing movement disorders. It discusses the prevalence of common movement disorders like Parkinson's disease and essential tremor. The key to diagnosis is accurately classifying the type of movement disorder present based on the clinical presentation. This involves defining the dominant abnormal movement as well as any associated neurological or non-neurological features. Once classified, the movement disorder can guide further diagnostic testing and help establish a differential diagnosis. The review will cover approaches to diagnosing akinetic-rigid syndromes and hyperkinetic disorders like tics, chorea, dystonia and tremor.
Resident Performance from the Patient's View: Richard Wardrop, MD, PhD, FAAPPicker Institute, Inc.
Principal investigator: Richard M. Wardrop III, MD, PhD, FAAP, FACP, WakeMed Faculty Physicians, Internal Medicine and Pediatrics, Assistant Professor at Virginia Tech Cailion School of Medicine and the University of North Carolina School of Medicine
The Resident Performance project intended to adapt an existing attendant-based evaluation into a patient-centered prototype tool that is concise, valid and reliable, and that enables patients to accurately assess resident performance on 4/6 ACGME competencies. Performance with regard to ACGME core competencies of residents who receive feedback and coaching using the patient-centered tool was compared to that of those who received attending-only feedback.
This document discusses home care in children and challenges families face administering medications at home. It provides examples of medication errors observed in home visits and identifies risk factors like increased number of medications and complex dosing schedules. The document recommends that doctors routinely ask families about their home medication administration process to identify difficulties and partner with families to develop support strategies and systems to prevent errors.
Scott W. Baumgartner is a rheumatologist and clinical researcher with extensive experience leading clinical trials and medical affairs functions at pharmaceutical companies. He has held roles such as Vice President of Medical Affairs and Clinical Research & Development at Ardea Biosciences and Amgen, where he oversaw global clinical development programs and medical evidence generation activities. Currently, he works as an independent consultant providing advice to pharmaceutical companies on various healthcare issues.
Dr Pradeep Jain Fortis Hospital - CURRICULUM VITAE. Dr Pradeep Jain Fortis Hospital has the widest spectrum of advanced Laparoscopic Surgery in GI Surgery field.
This document lists over 70 potential topics for nursing research projects related to medical/surgical nursing. The topics cover a wide range of clinical areas and patient populations, and focus on assessing the effectiveness of various nursing interventions like education programs, relaxation techniques, yoga, and more. Many of the proposed studies would take place in selected hospitals in Mehasana, India.
Marly Jiby is a registered nurse seeking a position in medical surgical, telemetry, or psychiatric nursing. She has over 15 years of nursing experience in medical surgical, emergency room, and intensive care settings in both the United States and India. Her experience includes providing direct patient care, monitoring conditions, collaborating with healthcare teams, and maintaining compliance with policies and procedures. She has certifications in medical surgical nursing, ACLS, and BCLS.
This document outlines a study conducted by Anjalatchi to assess the knowledge of staff nurses regarding prevention and management of perineal tears during normal delivery. The study was conducted at selected hospitals in Lucknow, India between 2019-2021. A questionnaire was developed and administered to 250 staff nurses to collect data on their knowledge. The results found that the majority of nurses had average knowledge, while some had poor or good knowledge. Overall knowledge was higher regarding management of tears compared to prevention. The study aims to identify gaps in nurse knowledge to help develop an educational module for improving care of mothers during childbirth.
The document provides guidelines for conducting research on health disaster response. An international panel of experts developed a consensus on research priorities and a mixed-methods approach. The priorities include assessing community preparedness before a disaster and evaluating the response and health impacts after. A mixed-methods approach using both qualitative and quantitative data is recommended to improve the quality of evidence-based research on disaster medicine.
HRSA Comprehensive Geriatric Education Grant Posternomadicnurse
This grant funds a Clinical Nurse Specialist position to work with current Gerontological CNS in providing education, mentoring / support, developing / measuring outcomes for knowledge, practice change and patient outcomes by:
Expanding NICHE training at Piedmont Hospital in Atlanta beyond Acute Care nurses to include Emergency Department nurses;
2) Introducing NICHE training at Piedmont Fayette, Piedmont Newnan and Piedmont Mountainside for Acute Care and Emergency Department nurses;
3) Introducing NICHE training for nursing staff at two of our Long-Term Care facility partners; and
4) Disseminating program materials and information to other healthcare entities throughout Georgia and the U.S. through local workshops and presentations at national healthcare conferences.
This study assessed patients' attitudes regarding nursing students' involvement in their care at BPKIHS. Most patients reported positive attitudes. Specifically:
- Over 90% felt glad about student nurses' presence, believed they can ask questions, and liked how student nurses examine them in detail.
- Over 50% felt student nurses devote more time, help in treatment, and examine thoroughly.
- Over 80% believed student nurses have disease knowledge and good behavior.
However, some patients felt student nurses could improve by developing more helping attitudes, treating all patients equally, and counseling patients and families. Overall, most patients welcomed student nurses' involvement and perceived educational benefits.
This research proposal outlines a quantitative study that aims to investigate nurses' attitudes, knowledge, and experiences in prioritizing comfort measures for dying patients in an acute hospital setting. A literature review identified key themes in end-of-life care including identifying the dying phase, providing comfort care, and managing symptoms. Several studies found that nurses and doctors differed in their approaches, with nurses more focused on comfort and doctors on cure, hindering optimal end-of-life care. The proposal will survey 200 nurses using questionnaires to assess their perspectives on comfort care for the dying. The goal is to identify needed interventions through education, training, and management to improve end-of-life care for patients in Irish hospitals.
- Evidence-based practice (EBP) involves integrating the best research evidence, clinical expertise, and patient values and needs.
- EBP follows steps including asking questions, locating evidence, critically appraising evidence, integrating the information, and evaluating outcomes.
- Nursing research is important for EBP as it provides empirical knowledge through describing phenomena, explaining relationships, predicting outcomes, and enabling control of situations by testing interventions.
This study evaluated time-to-event analytic methods for health economic evaluation. It discussed challenges in estimating accurate transition probabilities in the presence of competing risks, recurrent events, and time-varying factors. It reviewed the state of the science for time-to-event analysis in cost-effectiveness analysis and described three techniques - multi-state Markov models, frailty models, and marginal structural models - to address methodological challenges posed by time-to-event data. The study concluded by calling for continued methodological development in time-to-event analytic methods to better address issues like competing risks, recurrent events, and time-dependent exposures in health economic modeling.
Overview and Future of Nursing ResearchEnoch Snowden
Nursing research has evolved significantly over time. It began with Florence Nightingale's work but gained more prominence in the 20th century. Several important developments have occurred in India as well, including establishing research societies and increasing PhD programs. Looking ahead, nursing research is expected to focus more on evidence-based practices, systematic reviews, and interdisciplinary collaboration to continue improving patient outcomes.
Improving End-of-life Care in the Emergency DepartmentMichael Gisondi
Grand Rounds lecture presented at Palmetto Health Richland Emergency Medicine Residency Program / University of South Carolina School of Medicine, August 2016. Reviews the concept of Primary Palliative Care in the ED and the research efforts of The EPEC-EM Project: Education in Palliative and End-of-Life Care in Emergency Medicine.
The document discusses a PICOT project focused on enhancing pain management through nurse education. It aims to reduce hospitalization rates by providing more frequent educational opportunities for nurses to improve patient outcomes. The training will target technology-based pain management and communication approaches. A literature review found that organizational leadership, adequate staffing and resources are key to effective pain management. Barriers like gaps in education and communication must be addressed. The project will use Lewin's change model and a knowledge-to-action framework to provide topic-specific education, assess gaps, collect data, and support continuous learning to improve clinical practices long-term. The goal is a 5% reduction in cancer-related hospitalizations in the local area.
The document discusses the history and development of nursing research from its origins in the 1850s led by Florence Nightingale to current priorities and trends. Some key events include the establishment of the first nursing research organization Sigma Theta Tau in 1936, increased government funding of nursing research beginning in the 1940s-1950s, and the establishment of the National Institute of Nursing Research in 1993 which significantly advanced the field. The document outlines priority areas for nursing research according to different specialties such as clinical nursing, nursing administration, and nursing education.
This review of literature summarizes several studies related to perineal tears during childbirth. Some key findings include:
1) Studies found higher rates of anal incontinence and impaired pelvic floor structures in women who experienced undiagnosed or missed perineal tears compared to diagnosed tears.
2) Techniques like warm compresses, perineal massage, and hands-off positioning were found to reduce rates of severe perineal tearing in some studies.
3) Operative vaginal deliveries and midline episiotomies were associated with higher risks of anal sphincter injuries and severe perineal trauma in several studies.
4) Implementation of checklists and
A document prepared by Dr. Mustafa Salih, the former director of the Directorate General of Health Policy, planning and research at the Federal ministry of Health in Sudan.
This document provides an introduction to a review article about the clinical approach to diagnosing movement disorders. It discusses the prevalence of common movement disorders like Parkinson's disease and essential tremor. The key to diagnosis is accurately classifying the type of movement disorder present based on the clinical presentation. This involves defining the dominant abnormal movement as well as any associated neurological or non-neurological features. Once classified, the movement disorder can guide further diagnostic testing and help establish a differential diagnosis. The review will cover approaches to diagnosing akinetic-rigid syndromes and hyperkinetic disorders like tics, chorea, dystonia and tremor.
Resident Performance from the Patient's View: Richard Wardrop, MD, PhD, FAAPPicker Institute, Inc.
Principal investigator: Richard M. Wardrop III, MD, PhD, FAAP, FACP, WakeMed Faculty Physicians, Internal Medicine and Pediatrics, Assistant Professor at Virginia Tech Cailion School of Medicine and the University of North Carolina School of Medicine
The Resident Performance project intended to adapt an existing attendant-based evaluation into a patient-centered prototype tool that is concise, valid and reliable, and that enables patients to accurately assess resident performance on 4/6 ACGME competencies. Performance with regard to ACGME core competencies of residents who receive feedback and coaching using the patient-centered tool was compared to that of those who received attending-only feedback.
This document discusses home care in children and challenges families face administering medications at home. It provides examples of medication errors observed in home visits and identifies risk factors like increased number of medications and complex dosing schedules. The document recommends that doctors routinely ask families about their home medication administration process to identify difficulties and partner with families to develop support strategies and systems to prevent errors.
The document provides information about a lupus health passport, including sections on personal contact information, classification criteria for lupus diagnosis, hospital admissions, preparing for clinic visits, medications commonly used to treat lupus, and notes pages. It is intended to help patients organize health information and prepare for doctor visits.
EMPACT: Emergency Medicine Professionalism and Communication TrainingPicker Institute, Inc.
"Emergency Medicine Resident Training in Interprofessional Skills: Evaluating a Needs-Based Curriculum"
Sondra Zabar, M.D., Principal Investigator Associate Professor of Medicine
Linda Regan M.D., Co-Investigator New York University School of Medicine
EMPACT aims to expand on previous work by assessing and improving EM resident competency in communication and professionalism through the development, implementation, and evaluation of new curriculum and assessment measures.
This document describes a program developed to train nurses and residents at a community hospital as a patient-centered care team. The program involved 3 main steps: 1) consolidating patients onto a single medical ward, 2) training individual nurses and residents in patient-centered communication skills, and 3) implementing activities to build trust and respect between nurses and residents through formal and informal interactions. Preliminary findings indicate that training in patient-centered care principles was key to facilitating administrative interactions between nurses and residents, and that both groups have been enthusiastic participants. The program represents a unique approach to training interprofessional teams and is undergoing rigorous evaluation.
Improving Patient Rounds (IPR): Medical College of Georgia/Georgia HealthPicker Institute, Inc.
This document summarizes a quality improvement project to implement patient- and family-centered care (PFCC) rounds at a hospital. The project aims to engage patients and families as partners in care, decision-making, and discharge planning. Outcomes included improved communication and satisfaction for patients, families, and nurses. Challenges included patient advisor training and coordinating interdisciplinary teams. Strategies to overcome challenges included designating consistent patient observers, establishing a PFCC rounds schedule, and providing team building. The document describes using an observation checklist to assess communications and provide feedback to improve PFCC rounds.
The document provides a mnemonic to help healthcare providers effectively communicate with patients and their families. The mnemonic is POTHOLEs, with each letter standing for an element of patient-centered care. These elements include listening to patients, orienting them to their treatment and care, checking their understanding, treating them with kindness and respect, providing timely care, allowing them to explain their needs and concerns, and managing their expectations of what will happen.
This document outlines ways to improve the patient experience through always events. It recommends paying attention to patients, actively listening to them, and ensuring timeliness. It also suggests introducing all team members, managing expectations through clear communication, using nice manners, and testing patient understanding.
The document discusses strategies for improving patient-centered care. It focuses on ensuring patients feel oriented, informed, and involved in their care. This includes introducing all medical staff, explaining plans in plain language, checking for understanding, keeping patients updated on delays, allowing them to explain concerns, and setting clear expectations for next steps. The goal is for patients to understand their care and feel their needs, preferences, and questions are being addressed.
Integrating Patient- and Family-Centered Care Principles into a Simulation-Ba...Picker Institute, Inc.
This document provides guidance on effectively sharing bad news with patients. It introduces the SPIKES protocol, a 6-step model for delivering bad news. The steps are: Setting, Perception, Invitation, Knowledge, Emotions, and Strategy/Summary. The document emphasizes creating the right environment, understanding the patient's perspective, delivering the news with empathy, assessing the patient's emotional response, and creating a follow-up plan. The goal is to share information in a supportive, compassionate manner that meets the patient's needs and preferences.
This document provides information about discussing goals of care with family members of patients with dementia. It begins with an introduction and outlines the session goals. It then discusses the natural history and progression of Alzheimer's disease using the FAST scale. Data on the clinical course of advanced dementia is presented showing high rates of infections, eating problems, and burdensome interventions in the last months of life. Evidence is discussed regarding treating or not treating pneumonia and tube feeding. The role play provides an example case of a patient with advanced dementia to discuss goals of care.
This criterion is linked to a Learning OutcomeOutcome Analysis Par.docxrhetttrevannion
This criterion is linked to a Learning OutcomeOutcome Analysis Part B
Narrative Analysis
1. Using synthesis and evaluation, the student authors a 3,000-4,500 word scholarly reflective narrative that demonstrates how all of the artifacts submitted, and the course in which the artifacts were produced, meet each MSN/FNP Program Outcome; AND
2. The student provides summative evaluation of their own professional growth and development as a graduate student in the COGNITIVE, PSYCHOMOTOR, and AFFECTIVE domains as it pertains to the FNP Program; AND
3. The student provides summative evaluation of their own professional growth and development as a graduate student as it pertains to AACN’s MSN Essentials for Graduate Education; AND
4. The student provides summative evaluation of their own professional growth and development as a graduate student as it pertains to the National Organization of Nurse Practitioner Faculties (NONPF) Competencies; AND
5. The student reflects how one’s own cultural competence has been transformed.
RUNNING HEAD: Narrative Analysis: MSN-FNP Program 2
Narrative Analysis: MSN-FNP Program 2
Narrative Analysis: MSN-FNP Program
Amber Cajina
Chamberlain University
NR667: FNP Capstone Practicum & Intensive
Dr. Rinehart
Oct 2022
Intro: MSN/FNP Program – Narrative Analysis
The purpose of this narrative analysis is to demonstrate the achievement of outcomes outlined in the MSN-FNP program. Chamberlain University's Master of Science in Nursing, Family Nurse Practitioner program. In order to prove how meticulously the program provided a guided and well-planned academic framework that achieved the goal of success and accomplishment that is required as an FNP. This analysis consists of an evaluation to demonstrate how the FNP program outcome correlates with the assignments selected for the eportfolio and how the courses also create a link to the chamberlain academic framework. The review will establish professional growth and development as a graduate student in the cognitive, psychomotor, and affective domains as it relates to this program. The duty of this analysis is also to connect personal advancements achieved through the program to the American Association of Colleges of Nursing (AACN) MSN Essentials for Graduate Education and the National Organization of Nurse Practitioner Faculties (NONPF) Competencies. Lastly, I will reflect on how my own cultural competencies have been transformed in the completion of the MSN/FNP program.
MSN-FNP Program Outcomes
There are five program outcomes in the Chamberlain College of Nursing Family Nurse Practitioner program and they include: “1. Provide high quality, safe patient centered care grounded in holistic health principles, 2. Create a caring environment for achieving quality health outcomes, 3. Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity, .
The document describes a study conducted by researchers at the University of Missouri School of Medicine to develop a tool to evaluate the potential for patient centeredness in medical school applicants based on their personal statements. They created the Patient Centered Personal Statement Scale (PCPSS) which rates personal statements on a numerical scale according to behaviors indicating patient centeredness. Raters using the PCPSS showed high agreement levels. A survey found admissions committee members found the PCPSS accurately reflected their views of applicants' potential for patient centeredness, though it did not strongly influence all members' assessments. The researchers conclude the PCPSS may be a useful tool for medical schools to evaluate this quality in applicants.
This simulation-based resident-as-teacher program aimed to improve residents' teaching skills through a workshop, facilitating simulation cases for interns, and receiving feedback. 41 residents participated. Their pre- and post-program self-assessments of teaching skills showed significant improvements, especially in teaching in a simulated environment. Interns highly rated the curriculum and reported residents frequently used debriefing techniques from the program. The program provided a controlled environment for residents to practice teaching with feedback, improving their skills.
The brain recovery core- Building a system of organized stroke reRachel Danae V
This document describes the Brain Recovery Core (BRC) system, which was created to build an organized system of stroke rehabilitation across institutions. The BRC is a partnership between Washington University and two hospitals. It aims to standardize assessments, collect data across settings, and improve outcomes. The BRC developed a standardized assessment battery for physical therapy to be used consistently from the acute to outpatient stages. Implementation involved educating staff and monitoring compliance. Follow-up assessments at 6 and 12 months were also established to measure long-term outcomes after rehabilitation ends.
Literature Evaluation TableStudent Name Vanessa NoaChange.docxmanningchassidy
Literature Evaluation Table
Student Name: Vanessa Noa
Change Topic (2-3 sentences): Patient safety is one of the pertinent issues in nursing home health care. The literature evaluation table summarizes the strength and relevance of eight peer-reviewed articles on the role of nurse education on fall prevention.
Criteria
Article 1
Article 2
Article 3
Article 4
Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
Author: Howard Katrina
Journal: MEDSURG Nursing
https://www.thefreelibrary.com/Improving+Fall+Rates+Using+Bedside+Debriefings+and+Reflective+Emails%3A...-a0568974192
Authors: Jang and Lee
Journal: Educational Gerontology
Link: https://doi.org/10.1080/03601277.2015.1033219
Authors: Kuhlenschmidt et al.
Journal: Clinical Journal of Oncology Nursing
Link: https://doi.org/10.1188/16.CJON.84-89
Authors: Minnier et al.
Journal: Creative Nursing
Link: https://doi.org/10.1891/1078-4535.25.2.169
Article Title and Year Published
Title: Improving Fall Rates Using Bedside Debriefings and Reflective Emails: One Unit’s Success Story
Year: 2018
Title: The Effects of an Education Program on Home Renovation for Fall Prevention of Korean Older People
Year: 2015
Title: Tailoring Education to Perceived Fall Risk in Hospitalized Patients With Cancer: A Randomized, Controlled Trial
Year: 2016
Title: Four Smart Steps: Fall Prevention for Community-Dwelling Older Adults
Year: 2019
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study
RQs: Why falls remain a challenging and complex problem
What innovative measures can reduce patient falls
Quantitative research
Aim/purpose: To discuss a project that seeks to implement innovative measures that help decrease patient falls
RQs: Does an education program on home renovation reduce falls among older people?
Quantitative study
Hypothesis: Appropriate education is crucial for fall prevention
Aim/Purpose: To verify the impacts of an education program on home renovation for preventing falls among older adults
RQs: Are there evidence-based interventions tailored to the perception of falls risk
Quantitative study
Aim/Purpose: To determine the effects of tailored, nurse-delivered interventions
RQs: Do guides for fall prevention enhance older adults’ knowledge and awareness of fall risks.
Quality improvement project
Aim/Purpose: To implement a simple, author-designed guide for fall prevention among older adults dwelling in the community
Design (Type of Quantitative, or Type of Qualitative)
Survey
Quasi-experimental
Randomized, controlled design
Narrative model
Setting/Sample
A team of clinical staff and leaders
51 participants
91 patient participants
Senior center
Methods: Intervention/Instruments
Open discussions to enable clinical staff to discuss concerns and provide feedback
In-depth interviews and survey
A two-group, controlled design. This design helped to test interventions in the bone marrow plantation unit
The prevention program dubbed Fou.
The document summarizes a project called Project Walk that implemented an interdisciplinary early mobilization program for adult medical-surgical inpatients at a large academic medical center. Nurses used a mobility assessment tool and algorithm to identify patients for either nurse-led or physical therapy-led mobilization. Implementation strategies included staff champions, leadership rounding, and focus groups. Process measures like assessment completion and ambulation frequency improved. Outcome measures like falls, VTEs, and length of stay saw reductions after implementation of Project Walk.
ICVAP HRSA Grant Newsletter Winter 2016Jack DeVault
The document summarizes an interprofessional collaboration project at West Virginia University aimed at improving care for vulnerable patients. A team from WVU Schools of Nursing, Medicine, and Pharmacy received a $1.4 million grant to implement an interprofessional care model. The model will be tested through simulations and rolled out to hospital units. It focuses on enhancing teamwork and collaboration between nurses, doctors, pharmacists and other providers. The goal is to improve patient outcomes by reducing complications and readmissions.
The annual report summarizes the accomplishments of the Department of Emergency Medicine from July 1, 2014 to June 30, 2015. It highlights increased faculty and resident numbers, the opening of a new emergency department, and expanded research, education, and clinical programs. It provides details on faculty awards, publications, grants, and leadership roles both within the department and for professional organizations. The report demonstrates the significant growth and achievements of the department during the past academic year.
REFERENCES FOR THE TWO ARTICLESQUANTITATIVEARTICLE 1McIe, S.docxdebishakespeare
REFERENCES FOR THE TWO ARTICLES
QUANTITATIVE
ARTICLE 1
McIe, S., Petitte, T., Pride, L., Leeper, D., & Ostrow, C. L. (2009). Transparent film dressing vs. pressure dressing after percutaneous transluminal coronary angiography. American Journal of Critical Care, 18(1), 14–20.
QUALITATIVE
ARTICLE 2
Osterman, P. L., Asselin, M. R., & Cullen, H. A. (2009). Returning for a baccalaureate: A descriptive, exploratory study of nurses’ perceptions. Journal for Nurses in Staff Development, 25(3), 109–117.
J O U R N A L F O R N U R S E S I N S T A F F D E V E L O P M E N T � Volume 25, Number 3, 109–117 � Copyright A 2009 Wolters Kluwer Health l Lippincott Williams & Wilkins
One critical role of the staff development spe-cialist is to facilitate competence and contin-
ued professional development of staff (American
Nurses Association, 2000). One approach to this is to
foster an environment which encourages staff to
advance academically, be it from the diploma or
associate’s degree to the baccalaureate level or
beyond. This is especially timely given the push for
Magnet recognition in many hospitals and given the
spotlight that has been placed on quality outcomes
and a culture of safety. Furthermore, although hos-
pitals struggle with fiscal challenges, the financial
benefit of supporting nurses who pursue advanced
education may not be immediately visible to admin-
istrators, but staff development specialists realize the
value of such a move, especially about improving
patient outcomes and enhancing patient safety.
When examining the impact of nurses’ educational
preparation on patient outcomes, Aiken, Clarke, Cheung,
Sloane, and Silber (2003) recognized
a statistically significant relationship between the propor-
tion of nurses in a hospital with bachelor’s and master’s
degrees and the risks of both mortality and failure to
rescue. . .Each 10% increase in the proportion of nurses
with [bachelor’s or master’s] degrees decreased the risk of
mortality and of failure to rescue. . .by 5%. (p. 1620).
Although this study has been the subject of some
controversy within the nursing profession, most
scholars agree that ‘‘[e]ducation makes a difference
in nursing practice. . .education broadens one’s knowl-
edge base, enriches understanding, and sharpens
expertise’’ (Long, Bernier, & Aiken, 2004, p. 48). The
value of these educational benefits, when applied to
patient care, is further clarified by the observation that
[n]urses constitute the surveillance system for early de-
tection of complications and problems in care, and they
are in the best position to initiate actions that minimize
negative outcomes for patients. That the exercise of clinical
judgment by nurses. . .is key to effective surveillance may
explain the link between higher nursing skill mix. . .and
better patient outcomes (Aiken et al., 2003, p. 1617).
The need for increasing numbers of baccalaureate-
prepared registered nurses (RNs) becomes more ob-
vious when viewed through the le ...
This summary provides the key points from the results section of the research document:
1. The results were categorized into three areas: recovery oriented care, therapeutic milieu, and correlations between patient centered measures.
2. Statistical tests like the Pearson correlation coefficient and t-tests were used to analyze the results.
3. The results indicated that patients and providers perceived the level of recovery-oriented services in the forensic mental health hospital to be satisfactory. However, patients' ratings for treatment options and discussing spiritual needs were lower.
4. Some significant differences in scores were also found between patients and providers.
The document describes 4 projects that received Challenge Grants from 2008-2009 focused on improving patient-centered care:
1) The TAP project at UCSF developed a transition program for adolescents with chronic conditions moving to adult care including resident training, a transition handbook for patients, and found a need for improved transition preparedness.
2) The IPR project at Medical College of Georgia implemented and measured patient-centered rounds on medicine units, identifying strategies to overcome obstacles and a blueprint for wider adoption.
3) The Resident Performance project at Carillion Clinic adapted an evaluation tool for patients to assess residents' competencies, finding it reliable for comprehensive feedback.
4) The Patient-Centered
By administering assessments and analyzing the results, targeted aTawnaDelatorrejs
By administering assessments and analyzing the results, targeted and individualized interventions can be determined to best serve the needs of students with disabilities. The actual implementation of the interventions provides teachers opportunities to collect data and gauge the effectiveness of the interventions in addressing documented student needs. Teachers can also gain important skills and knowledge on how to best advocate for practical classroom interventions. Teachers will also be able to collaborate with colleagues and families in mentoring students to take ownership of learning strategies.
Allocate at least 2 hours in the field to support this field experience,
Part 1: Assessment and Interventions
Select at least one student to whom you will administer the informal RTI assessment created in Clinical Field Experience A. Score the assessment and share the results with the student to increase understanding of his or her strengths and areas for improvement.
Collaborate with the certified special education teacher and the student to develop 2-3 interventions based on the student assessment data to support the student’s progress in the classroom. In addition, detail one intervention that can be incorporated at home with family support.
Use any remaining field experience hours to assist the teacher in providing instruction and support to the class.
Part 2: Reflection
In 250-500 words, summarize and reflect upon the following:
· Describe each intervention, including teacher, student, and family roles, where applicable.
· Your experiences administering the assessment, analyzing the results, and providing the student feedback on his or her performance.
· Explain how you expect the interventions you developed to meet the needs of the student, incorporating his or her assessment results in your response.
· Explain how you will use your findings in your future professional practice.
APA format is not required, but solid academic writing is expected.
This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
6
Annotated Bibliography
Student’s Name
Course
Instructor’s name.
Institutional Affiliation
October 7, 2021.
Annotated Bibliography
Ali, H., Ibrahem, S. Z., Al Mudaf, B., Al Fadalah, T., Jamal, D., & El-Jardali, F. (2018). Baseline assessment of patient safety culture in public hospitals in Kuwait. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2960-x
The researchers conducted a cross-sectional study in 16 public hospitals in Kuwait using the Hospital Survey on Patient Safety Culture (HSOPSC). The study aimed to assess patient safety culture in public hospitals as perceived by hospital staff and relate the findings similar to regional and international ...
Better data for teachers, better data for learners, better patient care col...Edgar Febles
The document discusses the establishment of the Office of College-wide Assessment at Michigan State University's College of Human Medicine. The office was created to oversee the development and implementation of a comprehensive assessment system aligned with the college's competency-based curriculum. The goals of the office are to provide better data on student performance to teachers for curriculum improvement, better feedback to students, and ensure patients receive competent care. The office is led by an Associate Dean and aims to create continuity in assessment from undergraduate to graduate medical education. It facilitates collaboration across the college and engagement of faculty expertise to design, analyze and provide feedback from assessment data.
This document discusses a student's weekly reflective journal entries for their capstone practicum course. The journal covers several topics, including identifying health disparities in the community, creating objectives for a proposed negative pressure wound therapy project, discussing new approaches like telehealth nursing, and understanding how health policy and clinical systems work. The student demonstrates several competencies, including identifying health disparities, setting measurable objectives, considering the role of technology, and understanding how new practices are implemented in healthcare organizations.
1) The document discusses a student's reflective journal entries for their capstone practicum project over 10 weeks.
2) In early weeks, the student assessed their healthcare setting's needs and identified potential project topics, focusing on reducing health disparities.
3) For one topic on implementing negative pressure wound therapy, the student created objectives to improve outcomes and safety through new approaches.
4) Later weeks discuss exploring telehealth nursing and considering new policies, technologies, and how they can ethically benefit patients while maintaining standards of care.
The document discusses medical education in the 21st century. It begins with an overview of trends in U.S. undergraduate medical education including longitudinal clinical programs and a movement toward competency-based evaluations using Entrustable Professional Activities (EPAs). Next, it discusses changes in clinical undergraduate medical education such as longitudinal integrated clerkships and EPA-based evaluations. Finally, it reviews graduate medical education, noting new requirements from the ACGME, and novel approaches using digital resources, asynchronous learning theory, and social media.
This document discusses integrating patient safety education into the undergraduate obstetrics and gynecology curriculum. It provides a literature review on existing patient safety curricula and assessments. The key points are:
1) While patient safety initiatives have increased in healthcare, medical student involvement remains limited. Incorporating students can help meet Accreditation Council for Graduate Medical Education competency milestones.
2) The literature provides some examples of successful patient safety curricula covering topics like teamwork, universal precautions, and aseptic technique. However, most studies lack outcome data proving the curricula changed student behavior.
3) High-fidelity simulations and skills training show promise in teaching concepts like team communication,
The Always Events Recognition Program aims to recognize healthcare organizations that have implemented programs meeting the criteria of an Always Event - actions that should always be performed to provide an optimal patient experience. Organizations can apply by submitting a letter describing their program and how it meets the Always Events criteria of being significant, evidence-based, measurable, and affordable. The letter must also outline how the program involves patients/families, has leadership support, engages staff, and is evaluated for effectiveness. Registered programs will be listed on the Always Events website and organizations can promote their work using the Always Events brand.
This document provides a blueprint for using Always Events to transform healthcare organizations and improve the patient experience. Always Events refer to aspects of care that are so important to patients that providers should always perform them consistently. Over 80 organizations have implemented Always Events projects to address challenges like communication, care transitions, patient and family engagement, and safety. Their results and lessons learned provide a roadmap for other organizations. The blueprint describes how healthcare leaders, educators, and other stakeholders can use Always Events to advance patient-centered care and transform the healthcare system.
The document describes Always Events, which are practices that should always occur to improve the patient experience. It then summarizes initiatives from 20 organizations to address common healthcare challenges through Always Events. One area is care transitions, where several grantees developed Always Events focusing on hospital discharge, handoffs between providers, and reducing readmissions. For example, one organization implemented a "SMART Discharge Protocol" to ensure key information is discussed at discharge. Another developed a "Patient-Centered Bedside Shift-to-Shift Handoff" process to include patients in shift changes. The document provides contact information for each program to allow other organizations to learn from their work.
The document provides an overview of a teach-back training toolkit that aims to help healthcare providers learn to use teach-back effectively when communicating with patients. The toolkit includes tools and resources like an interactive learning module, coaching materials, and videos to teach providers the 10 elements of competence for using teach-back. It also describes what teach-back is and the various sections included in the toolkit to support its use.
My Story- University of Minnesota Amplatz Children's Hospital: Always EventPicker Institute, Inc.
The MyStory project was designed to personalize care for pediatric patients at the University of Minnesota Amplatz Children's Hospital by capturing each patient's unique story. It incorporates the psychosocial needs of pediatric patients to create individualized, patient-centered care and engage children in decision making. The MyStory tool documents each patient's story in the electronic health record and is used to personalize care and involve patients in care planning. Outcomes data shows improved patient satisfaction scores related to understanding their condition, involvement in care, and feeling like the hospital feels like home. Lessons learned include the importance of patient involvement, interprofessional collaboration, and using the electronic health record to consistently deliver a personalized experience.
The document describes a simulation-based training program developed by Dartmouth-Hitchcock Medical Center to improve physician-patient communication skills. The program engaged Patient Family Advisers as subject matter experts to design, deliver, and evaluate a two-hour module focusing on sharing bad news. Residents participated in simulated patient encounters and debriefing sessions. Evaluation measures included pre-and post-training assessments of resident confidence and standardized patient evaluations of resident performance. The program aimed to better utilize the medical center's simulation center and address communication skills and professionalism training.
Transplant Guardian Angels and Trauma Team Texting is a program that connects organ donors who have registered to donate with recipients waiting for an organ transplant. Through the program, living donors can send encouraging text messages to recipients waiting on the transplant list. The program aims to provide emotional support for transplant recipients during their wait, while also raising awareness about the need for organ donation.
This document outlines a project aimed at establishing a sustainable process for patient-centered care transitions. The goals were to (1) address what matters to patients, (2) provide actionable health information, and (3) share information across care settings. Partners implemented a process using an electronic personal health record called "How's Your Health" to survey patients in the hospital and after discharge. Results showed patients were more confident after hospital discharge but less so after skilled nursing discharge. Sustainability varied by site but engaged volunteers were key. Additional funding was received to focus on diabetes patients. Lessons included tailoring health IT to settings and supporting older adults, garnering volunteer interest, and engaging designated caregivers or volunteers.
This document describes a project to develop a patient-centered handoff process called ISHAPED at a hospital system. The project team collaborated with Patient and Family Advisory Councils to gather patient perspectives on handoffs. Based on interviews, five themes emerged around introducing nurses, communication, patient engagement, education, and privacy. An educational campaign was conducted after developing videos highlighting lessons. Surveys found that introducing nurses and several other factors positively influenced patient ratings of care. The project highlighted the importance of engaging patients and a culture change to patient-centered care.
This document describes Project PARIS, which aims to (1) improve medical trainees' knowledge and attitudes around family-centered care and (2) determine the ideal time for family-centered care education. The strategy involves family members teaching trainees about their child's hospitalization. Phase 1 involved 29 pediatric residents and Phase 2 involved 52 medical students. Both phases found significant improvements in attitudes but only residents' knowledge improved significantly. The lessons learned are that involving family faculty in training is a promising way to teach family-centered care principles required in pediatric training programs.
The Always Events Recognition Program aims to recognize healthcare organizations that have implemented programs meeting the criteria for an Always Event - actions that should always be performed to provide an optimal patient experience. Organizations can apply by submitting a letter describing their program and how it meets the criteria of being significant, evidence-based, measurable, and affordable for patients. The letter must also outline how the program was developed with patient partnerships, has leadership support, and staff engagement, and discuss evaluation measures and outcomes to date. Recognition provides marketing benefits and the opportunity to share best practices.
This interim report provides updates on MyStory's progress. It includes appendices that provide additional details on key aspects of the work. The report gives a status update on where the project is to date.
University of Minnesota Amplatz Children's Hospital Always Event: My StoryPicker Institute, Inc.
The document discusses an initiative at University of Minnesota Amplatz Children's Hospital called MyStory that aims to capture personal stories and preferences of pediatric patients admitted to the hospital. MyStory recognizes children as individuals rather than just patients. The goal is to personalize care provided based on each child's unique story and needs.
University of Maryland Graduate Medical Education Always Events Poster Presen...Picker Institute, Inc.
This study aimed to empower patients and optimize medication regimens through a multidisciplinary approach involving internal medicine residents and clinical pharmacists. Residents received training on prescription plans, polypharmacy, and financial issues and worked with pharmacists and patients to address medication-related issues. Results showed residents improved their self-efficacy and competency working with patients. Patients positively rated the collaborative process and valuable changes were made to their medication regimens. The multidisciplinary model provided residents with beneficial learning experiences and tools to enhance patient care.
This document describes a project at Exempla Saint Joseph Hospital to increase patient participation in managing their comfort and pain. The project team developed a menu that nurses use during pain assessments to offer patients six different "courses" of options for pain control, including comfort items, medication options, comfort actions, personal care items, relaxation options, and ways to reduce boredom. Initial results showed higher patient satisfaction scores for pain management. The team's goal is to implement the menu hospital-wide to consistently involve patients in deciding their own comfort plans.
Wake Forest Graduate Medical Education Always Events Poster PresentationPicker Institute, Inc.
This document describes the development of a new curriculum called the Acute Care for the Elderly Transition Program (ATP) aimed at improving medical residents' education around care transitions. The program involves second-year residents conducting in-home visits with two recently discharged patients to assess medication management, follow-up care, functional status, and social support. Initial implementation is planned for July 2011. Preliminary findings indicate the program will need orientation for residents and dedicated time on their rotation. Lessons learned so far show importance of resident buy-in, direct supervision, and evaluating impact on patient outcomes and learning.
The document outlines a plan by Henry Ford Health System to implement routine dementia screening for senior patients aged 70 and older using online cognitive and behavioral assessments, with positive screens receiving further evaluation, diagnosis if appropriate, treatment, and referral to social services for patient and caregiver support. The goal is to test this screening program in two primary care clinics over 6 months before evaluating outcomes and potential expansion to other primary care practices.
This document provides guidance and reminders for an educational session on informed consent. It instructs participants to turn off electronics and participate in a debriefing session. It outlines learning objectives around shared decision-making, the informed consent conversation, and obtaining consent consistent with standards. Key elements of the informed consent conversation are described, including setting the environment, discussing options and patient preferences, and documenting the discussion and patient decision. Potential challenges like incapacitated patients, treatment refusal, language barriers, and consent for minors are also addressed.
This document provides guidance for a training session on effectively sharing bad news with patients. It begins with reminders to turn off electronics and participate in debriefing. The document then defines bad news, outlines challenges and supports to sharing it, and presents the SPIKES model - a 6 step protocol for setting, assessing perception, inviting questions, providing knowledge, addressing emotions, and summarizing a strategy. A video demonstrates the SPIKES model and is followed by a discussion. The document concludes by thanking those involved in its development.
Picker Institute/Gold Foundation 2012-2013 Graduate Medical Education RFPPicker Institute, Inc.
This document announces a request for proposals from the Picker Institute/Gold Foundation for their 2012/2013 Graduate Medical Education Challenge Grant program. The grants aim to support innovative projects that facilitate patient-centered care and humanism in physician education. Up to 4 grants of up to $25,000 each will be awarded, requiring a 100% institutional match. Proposals are due by April 27, 2012 and should demonstrate how the project incorporates patient perspectives and humanism into residency training in a way that is measurable, sustainable, and aligned with the Picker Institute, Gold Foundation, and ACGME principles.
Picker Institute/Gold Foundation 2012-2013 Graduate Medical Education RFP
Zabar final report cg
1. Picker Institute/ACGME Challenge Grants
Project Name:
Emergency Medicine Resident Training in Inter-professionalism Skills
Evaluating a Needs-Based Curriculum
FINAL REPORT
(February 29, 2007 – April 15, 2008)
Date of Report: April 15, 2008
Grant Number: 16
Grantee Institution: New York University School of Medicine
Principal Investigator Information: Sondra Zabar, MD
Associate Professor of Medicine
New York University School of Medicine
550 First Avenue, OBV D401
New York, NY 10016
(212) 263-1138
szabar@breitezabar.com
Co-Investigator Information: Linda Regan, MD
Assistant Professor of Emergency Medicine
New York University School of Medicine
lregan@jhmi.edu
2. TABLE OF CONTENTS
A. EXECUTIVE SUMMARY (ABSTRACT)........................................................................................................2
B. INTRODUCTION (BACKGROUND)............................................................................................................3
C. METHODS (PROJECT IMPLEMENTATION AND ADMINISTRATION) ...........................................4
D. RESULTS............................................................................................................................................................9
E. DISCUSSION...................................................................................................................................................14
F. DISSEMINATION ..........................................................................................................................................16
G. FINANCIAL REPORT ...................................................................................................................................16
H. ATTACHMENTS ............................................................................................................................................17
ATTACHMENT – SAMPLE CASE AND CHECKLIST (MEDICAL ERROR).........................................................................18
ATTACHMENT – SAMPLE REPORT CARD ..................................................................................................................28
ATTACHMENT – SESSION OBJECTIVES .....................................................................................................................34
ATTACHMENT – SAMPLE POCKET CARD ..................................................................................................................35
ATTACHMENT – GOLD FOUNDATION ABSTRACT .....................................................................................................36
3. A. EXECUTIVE SUMMARY (ABSTRACT)
Since the 1960’s, Emergency Medicine (EM) researchers’ efforts have worked to
demonstrate the importance of patient-centered doctor-patient communication, only acknowledging
decades later that advancing such patient-centered care will require increased and effective provider
education. Having had experience with the development and implementation of a controlled study
on the impact of comprehensive, integrated clinical communication skills curriculum on student
patient-centered skills, the Section of Primary Care faculty at New York University School of
Medicine’s were prepared and eager to partner with Emergency Medicine faculty on this very
important topic. With the commitment of NYUSOM-Bellevue Emergency Medicine Residency
leadership, we created the Emergency Medicine Professionalism and Communication Training
(EMPACT) Project.
EMPACT aimed to improve EM resident competency in communication and
professionalism through the development, implementation, and evaluation of new curriculum and
assessment measures. Our objectives were to: 1) design, implement and evaluate patient-centered
healthcare curriculum for all 60 EM residents; 2) evaluate predictive validity of Objective Structured
Clinical Examinations (OSCEs) by assessing correlation of OSCE performance with actual resident
performance in emergent care setting for cohort of PGY2 residents (n=15); and 3) disseminate this
Patient-Centered Care educational program to EM programs nationally. We conducted EMPACT in
four phases: Phase I) established baseline competency of EM interns using a 5 station OSCE; Phase
II) integrated an interactive skills-based series of five workshops focusing on interpersonal and
professionalism skills—into monthly required EM seminar series; Phase III) conducted post-
curriculum OSCE to evaluate impact of curriculum; and Phase IV) developed and implemented two
“Unannounced” Standardized Patient (USP) cases.
In completing all four phases of the EMPACT Project, we learned a lot about our residents,
how to improve our OSCEs, and how to implement another USP project in the future. Residents
agreed that the curriculum helped them to improve on the strengths and weaknesses identified by
the OSCE. Our comparison of the residents’ pre- and post-OSCE performances has shown
significant improvement in overall Communication, Relationship Development, and Patient
Education Skills. Also, through our USP pilot, we learned that we will need a better understanding
of the system in which we practice before embarking on such an endeavor and more USP cases to
better gauge how residents perform in reality.
Even having taught communication skills in other disciplines, teaching the same skills in EM
provided rich learning opportunities for us as curriculum innovators, evaluators, and administrators.
It is clear that learners need and appreciate curricula that are interactive and role model key patient
centered skills. Performance based assessment, OSCE and Unannounced Patients though time
intensive are meaningful assessment tools for both learners and programs.
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 2
PI: Sondra Zabar, MD
NYU School of Medicine
4. B. INTRODUCTION (BACKGROUND)
Since the 1960’s, Emergency Medicine (EM) researchers’ efforts have worked to
demonstrate the importance of patient-centered doctor-patient communication, only acknowledging
decades later that advancing such patient-centered care will require increased and effective provider
education. 12 Having completed the Macy Initiative in Health Communication, a controlled study of
the impact of comprehensive, integrated clinical communication skills curriculum on student
patient-centered skills,3 the Section of Primary Care (PC) faculty at New York University School of
Medicine’s (NYUSOM) were prepared and eager to continue such work with the EM faculty on this
very important topic. Drs. Linda Regan, Jeffrey Manko, and Eric Legome, directors of the
NYUSOM-Bellevue Residency in EM, an integrated four-year residency dedicated to training highly
competent emergency physicians, shared this enthusiasm and began to plan for such an initiative.
Our program, entitled Emergency Medicine Professionalism and Communication Training
(EMPACT), expands on previous work by assessing and improving EM resident competency in
communication and professionalism through the development, implementation, and evaluation of
new curriculum and assessment measures. To ensure clinical competency of EM graduates in
delivering patient-centered care, we incorporated both ACGME core competency requirements and
several of the Picker Institute’s Dimensions of Patient-Centered Care into our program/research
design. Our objectives were to:
1. Design, implement and evaluate patient-centered healthcare curriculum for all 60 EM
residents;
2. Evaluate predictive validity of Objective Structured Clinical Examinations (OSCEs) by
assessing correlation of OSCE performance with actual resident performance in
emergent care setting for a cohort of PGY2 residents (n=15); and
3. Disseminate this Patient-Centered Care educational program to EM programs nationally.
1
Korsch BM, Negrete VF. Doctor-patient communication. Sci Am. 1972 Aug; 227(2):66-74.
2
Rhodes KV, Vieth T, He T, Miller A, Howes DS, Bailey O, Walter J, Frankel R, Levinson W. Resuscitating the
physician-patient relationship: emergency department communication in an academic medical center. Ann Emerg
Med. 2004 Sep; 44(3):262-7.
3
Kalet A, Pugnaire MP, Cole-Kelly K, Janicik R, Ferrara E, Schwartz MD, Lipkin M Jr., Lazare A. Teaching
communication in clinical clerkships: a model from the Macy Initiative in Health Communications. Acad Med.
2004; 79(6):511-20.
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 3
PI: Sondra Zabar, MD
NYU School of Medicine
5. C. METHODS (PROJECT IMPLEMENTATION AND ADMINISTRATION)
To achieve our objectives, we conducted EMPACT in four phases. (See Figure 1. Project
Timeline) In Phase I, we established a baseline competency of EM interns using a 5-station OSCE.
Phase II, we developed an interactive skills-based series of five workshops focusing on interpersonal
and professionalism skills and integrated them into required monthly EM seminar series. In Phase
III, we conducted a post-curriculum OSCE to evaluate impact of curriculum. In Phase IV, we
developed and implemented two cases for the “unannounced” standardized patient (USP) project.4
Figure 1. Project Timeline
3/2007 4/2007 5/2007 6/2007 7/2007 8/2007 9/2007 10/2007 11/2007 12/2008 1/2008 2/2008
Curriculum Curriculum Development Curriculum Implementation Curriculum Packaging
OSCE Development (Case Individual
Pre- Post-
Evaluation development, SP Data Analysis Report Card Generation Remediation of
OSCE OSCE
Recruitment & Training) Poor Performers
Generation of Program
“Unannounced” Program Development (Logistics of Data
Case Development “Patient” in Implementation in
SP Program Implementation) Analysis
computer record ER
Mid-
Project Production of manuscripts, abstract
year
Dissemination submissions, final summary reports, etc.
Report
Phase I - Establish baseline competency of EM interns using a 5-station OSCE
In order to determine effectiveness of our curriculum, we chose to evaluate a subset of
resident performance in a pre- and post-OSCE. We wrote five cases and developed checklists that
assessed communication skills in scenarios commonly encountered by EM residents (See Table 1.
OSCE Cases). The checklists used to evaluate residents’ performance included items that assessed
overall communication skills (information gathering, relationship development, and patient
education), case-specific skills, and whether patients would recommend seeing the resident as their
physician.
Table 1. OSCE Cases
OSCE Case Picker Dimension Communication Skills
Informed Consent Access; Respect for patient’s values, preferences, and Obtaining Informed Consent;
Via an Interpreter expressed needs; Information, communication and Patient Education; Dealing with
education Challenging Patient
Disclosing a Medical Respect for patient’s values, preferences, and expressed Rapport Building; Emotion
Error needs; Emotional support and alleviation of fear and Handling
anxiety
Delivering Emotional support and alleviation of fear and anxiety; Emotion Handling; Patient
Unexpected Bad Information, communication and education Education
News
Transferring Care to Coordination and integration of care; Transition and Interdisciplinary Communication;
Another Service continuity Telephone Skills
Using the Emergency Access; Respect for patient’s values, preferences, and Dealing with Challenging Patient;
Room for Primary expressed needs; Emotional support and alleviation of Emotion Handling; Patient
Care fear and anxiety; Information, communication and Education
education
4
Kravitz RL, Epstein RM, Feldman MD, Franz CE, Azari R, Wilkes MS, Hinton L, Franks P. Influence of Patients’
Requests for Direct-to-Consumer Advertised Antidepressants: A randomized controlled trial. JAMA 2005;293:1995-
2002.
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 4
PI: Sondra Zabar, MD
NYU School of Medicine
6. The preparation for the pre-OSCE included multiple preparatory steps. We trained five
standardized patients (SPs) to reliably and repeatedly portray their roles for the OSCE. SP training
sessions allowed the SPs to ask questions about their character, develop the improvisational range
that should be portrayed in their role, and practice how to consistently respond to participant
reactions. Prior to the pre-OSCE, we piloted the five cases and videotaped them to fine tune the
content of the cases and the checklists. Five EM chief residents, junior faculty, and medical students
were assessed as the participants. After reviewing the videos of their performances, examining the
data from checklists completed by the SPs, and hearing feedback from the participants in a
debriefing session, we adjusted the OSCE and checklist for clarity, timing, and realism. After making
the appropriate adjustments to the five cases, we were ready to launch the OSCE.
We conducted the pre-OSCE in three sessions. At each session, five residents went through
all five stations. All 15 PGY2 EM residents completed the OSCE. We chose to test the PGY2
because we believe, developmentally, the intervention will have the most impact at this stage of
learner. 90% of the OSCEs were audio and videotaped for the purposes of assessing inter-rater
reliability afterwards.
Colleen Gillespie, PhD, our evaluation researcher, compiled the feedback from faculty
observers and checklist data from SPs and summarized them as both a presentation for EM faculty
and report cards for each individual resident (See Attachments – Sample Report Card). The report
card noted each resident’s performance in five core areas: 1) communication, 2) overall
recommendation, 3) ratings of ability to apply expertise, 4) specific skills across cases, and 5) overall
case-specific skill scores. One case was not reliably scored (Delivering Bad News) and so scores
associated with that case should be interpreted with caution (details of how these scores were
calculated are included in the sample report card provided in the Attachments).
Overall, we noted there was room for improvement for all the residents in their Data
Gathering, Relationship Building, and Patient Education Skills. Residents performed best at Data
Gathering, less well at Relationship Building, and worst at Patient Education. As a group they also
scored low on Emotion Handling. Such information was also included in the report cards, which
demonstrated how the individual performed in comparison to the rest of the participants. This data
guided us in our focus and approach to key topics covered in the curriculum. Residents told their
program director that they found the OSCEs enjoyable and educational.
Phase II - Integrate an interactive skills-based series of five workshops —focusing on
interpersonal and professionalism skills—into monthly EM seminar series
We developed curricula based on the Macy model and other literature that taught five key
patient-care tasks, including: 1) relationship development and maintenance, 2) patient assessment, 3)
education and counseling, 4) negotiation and shared decision making, and 5) organization and time
management of EM. Our curriculum was composed of five one-hour interactive sessions that
addressed each of the core skills during the OSCE using different teaching modalities. (See Table 2.
EMPACT Course Schedule) We clearly delineated cognitive, skills, and affective objectives for each
session and highlighted them at the beginning of each session. We also created pocket cards that
included take-home points and a bibliography of relevant literature for each session. (See
Attachment X for the Session Objectives) Approximately 40 residents attended each of the session,
with ~10 PGY2 residents at each.
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PI: Sondra Zabar, MD
NYU School of Medicine
7. Table 2. EMPACT Course Schedule
Session Title Date Picker Dimension Communication Teaching Method
Skills
1. Making Every Session 08/01/2007 Respect for patient’s Patient Education, Videotape
Count: Effective values, preferences, and Rapport Building Reenactment and
Communication Skills in expressed needs; Debriefing, Mini
the Emergency Room Information, Lecture
communication and
education
2. Interdisciplinary 09/12/2007 Coordination and Conflict Negotiation; Audiotape Trigger,
Communication and integration of care; Telephone Skills Role Play
Respect Transition and continuity
3. Delivering Bad News 10/03/2007 Emotional support and Emotion Handling Videotape Trigger
in the Emergency alleviation of fear and from Medical TV
Department anxiety; Information, Show, Rolling Role
communication and Play between
education Attending and SP
4. Dealing with 11/07/2007 Access; Respect for Effective use of an Rolling Role Play
Culturally Diverse patient’s values, interpreter, Elements of between Residents
Populations in the preferences, and expressed informed consent and SP, Mini Lecture
Emergency Department needs; Information,
communication and
education
5. Discussing Medical 12/05/2007 Respect for patient’s Emotion Handling; Videotape Trigger
Errors in the values, preferences, and Patient Education; from Medical TV
Emergency Department expressed needs; Dealing with Show, Role Play with
Emotional support and Challenging Patient Small Groups
alleviation of fear and
anxiety
The first session, entitled “Making Every Session Count: Effective Communication Skills in
the Emergency Room,” aimed to provide residents with tools to maximize the effectiveness of their
communication with patients and their families. The session began with a videotaped reenactment of
OSCE case as a trigger for discussion. The session also included a PowerPoint presentation of how
residents performed in the OSCE overall and how they can improve their professionalism skills.
Residents’ feedback on this first session was very positive. They noted, “I feel the hurried
atmosphere of the ER causes the communication skills to atrophy. I think this was a useful
reminder of that and an effective tool relevant to ER situations.”
Our second session, entitled “Interdisciplinary Communication and Respect,” aimed to teach
residents to effectively work with the professionals around them to optimize patient care. This
session proceeded with a general discussion of how interdisciplinary communication can be both
positive and negative. Then, we played a re-enacted audiotape of the “Transferring Care to Another
Service” case they experienced in the OSCE, which we used as the trigger for discussion on how
interdisciplinary communication can be made better. A short lecture outlined the key steps and skills
to successful conflict negotiation and effective phone skills. Residents then participated in a role play
to practice these skills. We debriefed the role play as a large group to help residents identify what
personal traits or attitudes are barriers for successful interdisciplinary communication. We handed
out a pocket card summarizing an approach to conflict negotiation and telephone skills. A number
of residents stated that this was the first time these issues were ever addressed as part of their
curriculum. In particular, they said, “Good suggestions on how to approach multidisciplinary
communication. Short handout with key points helpful. Tape [was] very pertinent and important.”
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 6
PI: Sondra Zabar, MD
NYU School of Medicine
8. The third session, entitled “Breaking Bad News in the Emergency Department,” aimed to
improve residents’ effectiveness in their delivery of bad news and provide residents with facts about
post-death procedures. The session began with the viewing of a trigger video clip from the Fox
television series, “House,” where a patient is abruptly given an AIDS diagnosis by the maverick, Dr.
Gregory House. This led to a conversation about what contributes to the sensitivities and difficulties
of delivering bad news, regardless of how the residents may perceive the severity of the news to be
(e.g. broken limb, new diagnosis of disease, or death of a loved one). Then, the residents directed a
rolling role play between an SP and Dr. Regan, who had to break the news of a positive HIV
diagnosis. The roll play was stopped a few times midstream to allow for a discussion of possible
strategies to better manage the situation. The session concluded with the key take-home points,
including protocol on how to follow-up on death notification, which residents took with them on
pocket cards. The residents notes that this topic "...can be fairly dry, has been done so much in med
school, BUT this was a very strong revisiting of this hard issue.” In particular, they said the session
was “excellent because it was DYNAMIC… well prepared, very interactive. The role play was very
well done."
The fourth session, entitled “Dealing with Culturally Diverse Populations in the Emergency
Department,” aimed to improve residents interactions with culturally diverse patients and
understand appropriate use of interpreters in the ED. The session began with a discussion of the
challenges of providing cross-cultural care, including how different health beliefs affect patient and
provider behavior and how language can act as the most apparent barrier. The conversation turned
to the challenge of working with various kinds of interpreters and strategies to overcome common
errors. During this session, a pair of Bengali-speaking SPs participated in a role play with Dr. Regan,
who demonstrated a bad version. Residents were asked to strategize on how to improve the
interaction and asked to come up and interact with the sp in front of the group. We used a Rolling
Role Play as the educational strategy for this session. We concluded the session with a summary on
how to use interpreters better. Residents again took home pocket cards that reviewed the key skills.
They enjoyed the use of small group role play and said it was "a refreshing approach to this topic."
The fifth session, entitled “Medical Errors in the Emergency Department,” aimed to improve
resident’s effectiveness in their disclosure of medical errors. This session began with a viewing of a
videoclip from the NBC television series, “Scrubs,” where a resident debates whether or not to
expose a potential medical error he believes was committed by his friend and colleague. While
comical, this clip helped the residents to begin broaching the difficult topic. Then, the session
continued with a discussion of frequent barriers to the disclosure of medical errors in general, as well
as specific to the ED. Residents were then given a checklist of items to follow which represented
common good practice for this sensitive topic. After explicitly discussing the 5Ws (Who, What,
Where Why, and When), the session proceeded with a skills practice. Each group of three to five
residents were given a scenario where one resident played the patient and another played the
resident who had to deliver the news about one of three medical error scenarios. Each group was
facilitated by a faculty member. The rest of the group observed and scored the scenario with a
checklist, similar to that which the SP's would use during the OSCE. Each small group reported
larger group the key learning points from their scenario. The session ended with the viewing of a
final clip from “Scrubs,” where everyone is relieved to find out an error did not occur and a re-
emphasis on the take-home points for the session.
Phase III - Conduct a post-curriculum OSCE to evaluate impact of curriculum.
Two months following the final EMPACT session, we held the post-OSCE. For comparison
purposes, we used the same five cases as the pre-OSCE. Due to the availability of the SPs, however,
we needed to train new SPs for four of the five cases. However, we purposefully chose SPs whom
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PI: Sondra Zabar, MD
NYU School of Medicine
9. we have worked with in the past and found to be reliable raters. Consequently, we believe the overall
integrity of the OSCE remains the same.
The post-OSCE was held in three sessions, with approximately five residents attending each
session. All 15 EM PGY2s participated in the post-OSCE and completed all five stations. Again, for
interrater reliability purposes, each station was videotaped, with the exception of the Transfer Case,
which was audio taped.
Colleen Gillespie and Tavinder Ark, MSc, our research associate, collected feedback from
faculty observers, checklist data from SPs, and resident satisfaction data relating to both the
EMPACT OSCE and curriculum. They summarized all data into report cards for each individual
resident, this time with a comparison of how their performance differed in the two OSCEs. The
report card reported each resident’s comparative performance in five core areas: 1) communication,
2) overall recommendation, 3) ratings of ability to apply expertise, 4) specific skills across cases, and
5) overall case-specific skill scores. The comparative data of the pre- and post-OSCE are described
later in the Results section.
Phase IV - Develop and implement two cases for the “unannounced” standardized
patient (USP) project.
The USP portion of EMPACT, was both exciting and educational. To our knowledge, based
on an extensive literature search in PubMed and Medline, the use of USPs in emergency clinical
settings had not been done prior to our attempt. Despite posing us with many labor-intensive
challenges, with full prior consent of residents, support of department and hospital leadership, and
approval from our IRB, we launched the USP program in December 2007 and assessed 12 residents
through 17 successful USP encounters in the ER.
For comparison purposes and to protect our SPs, we chose to use the Medical Error and
Repeat Visitor cases for the USP visits, as they required non-invasive interventions by the residents.
Having obtained verbal confirmation from Medical Records, Registration, EM Nurses, EM
Attendings, and the radiologists, we were poised to begin this aspect of the project. As the USPs in
both the cases were supposed to have visited the Bellevue ER before, both cases required the entry
of previous medical notes, x-rays, MRIs, and labs in the medical record system. We obtained
specified Medical Record Numbers for the USPs. However, the challenges of this effort soon
became apparent.
The rate limiting step in setting up the Medical Error case was the time frame allowed by
MISYS, the medical records system, to enter prior visits into the record history. Because the USP
was supposed to have visited the ER two days prior to the actual USP visit, we needed a visit to be
opened two days prior in real time. The system would not allow us to enter future visits. This meant
that the Bellevue Hospital EM Admitting needed to be ready to open the visit when we asked two
days prior to the actual USP visit. This also meant that the PACS team, the group that handled all
radiology related issues, had to be ready to upload the X-ray images and reports onto the system
once the prior visit was opened. Because this was a voluntary effort on the part of the Admitting
and PACS, it took a few tries to come up with an efficient system for getting all the required
information adequately noted in the USPs fictitious medical records prior to the actual USP visit.
The main challenge of the Repeat Visitor case was the manipulation of the MRI images.
Based on the original version of our case, the USP was supposed to have visited the Bellevue ER
twice in the past and have taken MRI images here. In order to have the MRI images reflect the case
details of each visit (e.g. dates, patient name, etc.), we needed to edit more than 50 images per visit.
We consulted Sectra, the company that services our PACS system, who offered to write us a
program that would quickly do so for $12,000. Since this was not possible given our financial
situation, we ended up editing the USP case. In the new version, the USP visited another ER in New
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 8
PI: Sondra Zabar, MD
NYU School of Medicine
10. York City two times and got an MRI at another location. The USP then brought the MRI report to
the actual USP visit at Bellevue.
The third most prominent challenge of the USP project resulted from our need to limit the
number of informed people in the ER, the unpredictability of the ER, and the assignment of the
residents to the USP case on a given day. We tried to limit the number of people in the ER who
knew that a USP was present to avoid detection. Although we tried our best to have the USP triaged
exactly to where the targeted resident was supposed to be working on the given day, our efforts were
often thwarted by eager medical students, rotating orthopedic residents, or unexpected schedule
changes. During a few of our scheduled visits, the USPs were mistakenly examined by another care
provider while the target resident was called away to see a more acutely ill patient. The attending
may have known about the USP, but at times was engaged in the care of another patient when non-
targeted personnel elected to see the USP.
After 29 attempts, we successfully evaluated 17 of the 30 planned visits (five residents were
visited by both types of USPs, which accounted for ten of the visits). We audio taped ~71% of the
encounters (12/17), which we will use to establish intra- and inter-rater reliability. Following each
visit, we videotaped the USPs as they debriefed the entire experience and completed the checklists.
As the last USP visit was just completed on April 8, 2008, a comprehensive comparison of the USP
and OSCE performances is still pending.
D. RESULTS
The OSCEs assess residents’ clinical skills in two major areas: 1) Communication Skills and
2) Case-Specific Skills. The Communication Skills describe residents’ ability in information
gathering, relationship development and patient education skills. The Case-Specific Skills describe
the residents’ ability to perform skills specific to each case. They are divided into five broad
categories: 1) managing a difficult case, 2) accountability, 3) delivering bad news, 4) patient education
and 5) treatment plan and management.
For the EMPACT OSCE and USP visits, Communication and Case-Specific Skills questions
are rated by the SP on a 3-point scale of “not done” (resident did not perform the task at all),
“partially done” (the resident attempted the task, but did not do it entirely correctly), or “well done”
(the resident performed the task and did it correctly). In addition, residents’ were rated by the SPs
on the degree to which they would recommend this doctor to a friend based on their interpersonal
skills and expertise on a 4-point scale (1= Not recommend and 4= Highly Recommend). Residents’
Communication and Case-Specific Skills are calculated as the percent of items rated as “well done”
across all cases. The overall recommendation rating was based on interpersonal skills and expertise
was calculated across all cases as a mean average on a 4-point scale. These score was calculated
across all 5 cases. A pre and post comparison was conducted. For the USP visits, this score was
computed only across the repeat visitor case and broken wrist (medical error) and compared to the
pre and post of only these two cases.
D1. Resident Experience of EMPACT
Data on residents’ exposure to actual clinical situations similar to the OSCE cases highlight
the importance of having an opportunity to practice low frequency clinical situations: only 29%
reported encountering a situation involving giving bad news since the pre-curriculum OSCE and
slightly less than half (43%) reported exposure to a clinical situation involving a medical mistake.
Despite evidence reported below that residents made substantial improvements from pre- to post-
curriculum in some core clinical areas, from more than a third to close to half of residents reported
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PI: Sondra Zabar, MD
NYU School of Medicine
11. that their performance on the post OSCE was “about the same” as their performance on the pre
OSCE (depending on the case, % ranged from 36% to 50%). Most agreed that the OSCE helped
them identify their strengths and weaknesses (60%) and provided a good cross-section of cases
(74%). However, some skepticism of the value of OSCEs was also apparent as just over half did
not think that the OSCEs taught them something new (54%) or was a fair evaluation of their skills
(60%). When asked in an open-ended manner to describe what was most helpful about EMPACT
most focused on the OSCE (perhaps reinforced by having just completed the post OSCE!), focusing
on practice (“repeated exposure to clinical scenarios”) and on being able to assess and reflect on
one’s skills (“recognizing my triggers for what is a problem for me;” “self reflection about my
weaknesses,” “the situations are a good reflection of what we see in the ED and they highlight some
of the weaknesses we have in dealing with difficult situations. I know I tend to make the same
mistakes over and over again.”). Several residents simply said that the EMPACT “curriculum” was
the most helpful aspect of EMPACT overall.
D2. Impact of the Curriculum: Pre- vs. Post-Curriculum OSCE Results
Comparison of the pre- and post-curriculum OSCEs showed significant improvement in
residents’ overall Communication Skills (pre=53.4% SD 14.9% vs. post=65.5% SD 11.5%;
p=0.003). In particular, they improved on overall Relationship Development skills (pre=49.2% SD
21.5% vs. post=59.8% SD 17.8%; p=0.025) and especially in their overall Patient Education skills
(pre=31.6% SD 15.1% vs. post=57.0% SD 15.2%, p<.001).
In terms of residents’ case-specific skills, significant improvement from pre- to post-
curriculum was seen in the Repeat Visitor case (pre=38.7% SD 18.1% vs. post=73.3% SD 16.7%,
p<.001) and close to significant improvement in the Bad News case (pre=54.0% SD 15.5% vs.
post=66.9% SD 22.1%; p=.066).
SPs rated residents more highly in terms of the degree to which they would recommend
them (using a 4-point scale) for their interpersonal skills (pre=2.84 SD .58 vs. post=3.09 SD .41;
p=.066) and for their medical expertise (pre=2.90 SD .48 vs. post=3.19 SD .29; p=.014).
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 10
PI: Sondra Zabar, MD
NYU School of Medicine
12. Impact of EMPACT:
Pre-Curriculum vs. Post-Curriculum OSCE Communication Scores (n=15)
80%
74%
Pre Post
70%
70% p<.01
65%
p<.05
60% p<.001
60% 57%
53%
49%
50%
% Well Done
40%
32%
30%
20%
10%
0%
OVERALL Information Gathering Relationship Patient Education
COMMUNICATION Development
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 11
PI: Sondra Zabar, MD
NYU School of Medicine
13. Impact of EMPACT:
Pre-Curriculum vs. Post-Curriculum OSCE Case Specific Scores (n=15)
80%
p<.001 73% Pre Post
p<.10
70% 67%
59%
60%
54% 54% 53% 54%
53%
50%
% Well Done
44%
40% 39%
30%
20%
10%
0%
Bad News Interpreter Broken Wrist Repeat Visitor Transfer
(Medical Error)
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 12
PI: Sondra Zabar, MD
NYU School of Medicine
14. Impact of EMPACT:
Pre-Curriculum vs. Post-Curriculum Recommendation Ratings (n=15)
Highly 4
Recommend
Pre Post
p<.10 p<.01
3.19
3.09
3 2.90
Recommend 2.84
Recommend
w 2
Reservations
Not 1
Recommend
Recommendation - Interpersonal Skills Recommendation - Applic of Expertise
D2. Comparison of OSCE and USP Scores
A major goal of this project was to begin to explore how residents’ performance in an OSCE
relates to their actual clinical performance, at least as assessed by an USP. Given that the pre-OSCE
took place in July, the post in March, and the USP visits anytime between mid-January and early
April, scores generated from the USP visits were compared with both pre- and post-curriculum
OSCE scores. Although, we expected USP scores to be more highly correlated with post-OSCE
scores since they generally occurred closer in time. Twelve residents had at least one USP visit and 5
residents were visited by both USPs (Repeat Visitor and Medical Error). We report correlations for
both sets of data in order to maximize our sample size (including all 12 residents by reporting
whatever USP data is available for each resident be it one or two visits) and maximize our sample of
actual clinical performance (including only those 5 residents from whom we have two samples of
performance data, i.e., two USP visits).
Correlations between OSCE and USP Scores
At least 1 USP Visit (n=12) 2 USP Visits (n=5)
USP Scores Pre OSCE Post OSCE Pre OSCE Post OSCE
Overall .70 .17 .83 .53
Communication (p=.011) (p=.600) (p=.088) (p=.379)
Skills
Overall Case .63 .17 .64 .85
Specific Skills (p=.029) (p=.598) (p=.249) (p=.066)
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 13
PI: Sondra Zabar, MD
NYU School of Medicine
15. Results suggest that the USP scores are strongly correlated with the pre-OSCE scores for
both residents with one or more visits and for only those residents with an adequate sample of
clinical performance (both Repeat Visitor and Medical Error USP visits). However, it is only among
those with both USP visits that we see strong correlations with post OSCE scores. It may be that
residents’ performance on the pre-curriculum OSCE best represents how they are in actual clinical
practice while their performance on the post-curriculum OSCE was more reflective of how they
perform when being evaluated on the basis of clear criteria (as shared through the 5-session
curriculum). These exploratory results also demonstrate the importance of including multiple
samples of performance – one USP visit is probably not sufficient to obtain a true and accurate
picture of physician skills.
We assessed two additional dimensions of clinical performance: patient-centeredness (e.g.,
fully explored my experience of the problem, took a personal interest in me, earned my trust,
acknowledge impact of situation on my life) and the degree to which the resident “activated the
patient” (e.g., helped me to understand the nature and causes of my condition, helped me find out
about the different medical treatment options available, made me feel confident I can figure out new
solutions if my situation changes) (Hibbard ref). There is increasing evidence that these skills, along
with core communication and case-specific skills, are associated with important patient outcomes.
Therefore, we examined correlations between average scores residents received from USPs on these
items and their OSCE scores and found, as above, that both pre and post OSCE communication
and case-specific skills were strongly (albeit not significantly) and positively correlated with patient
centeredness and patient activation.
2 USP Visits (n=5)
Overall Communication Skills Overall Case Specific Skills
USP Scores
Pre OSCE Post OSCE Pre OSCE Post OSCE
Patient .56 .78 .79 .84
Centeredness (p=.326) (p=.120) (p=.112) (p=.078)
Patient .68 .60 .85 .84
Activation (p=.202) (p=.282) (p=.070) (p=.078)
E. DISCUSSION
There are many things we can learn from the development and implementation of a new
curriculum designed to help residents with their communication skills. Even having taught
communication skills in other disciplines, teaching the same skills in EM provided rich learning
opportunities for us as curriculum innovators, evaluators, and administrators
First, residents portray an outward confidence about their communication skills, which
lacked grounding in their assessment levels. Despite their relaxed attitude about the OSCE cases,
the data showed that they had difficulty with some of the scenarios. This came as a great surprise to
some, though the majority already knew there was some deficiency when questioned. Resident
reported they learned that: 1) without listening to what patients have to say about their condition, it
is difficult to hear what the patient is actually trying to convey, without appropriately providing
patient education, quality of care may be compromised, 2) without communicating effectively with
other disciplines, it will be difficulty to coordinate care, and 3) without demonstrating empathy,
kindness, patient satisfaction is hard to achieve. Having the opportunity to step back from the flurry
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 14
PI: Sondra Zabar, MD
NYU School of Medicine
16. of activities in the EM, residents were able to acknowledge their respective shortcomings in
communication skills and commit to improving them for their patients.
Second, residents received their feedback in a much more affirmative manner than we had
hoped. We are struck by their positive feedback for the “much needed” education on “basic skills”
that are essential for success as EM physicians. Their enthusiasm for this education is surprising and
gladly received. They have been instructive in helping us to design our curriculum so that they can
get the most out of the experience for their practical day-to-day use.
Third, as measured by a reliable and valid OSCE, the EMPACT project shows that a focused
curriculum, with five one-hour group interactive sessions on communications and professional
curriculum, can significantly improve residents’ rapport building and patient education skills. These
skills were tested months after the curriculum. Our curriculum is unique, not for its topics, but
because of the variety of educational methods we incorporated (i.e. role play, modeling with
standardized patients, discussion triggered by “TV medical clip” and reenactments of real residents’
performances). This approach is highly acceptable and engaging to residents, as evidenced by their
feedback.
Fourth, through the USP aspect of this project, a novel endeavor, we have shown that this
methodology is feasible and acceptable to residents, program directors, and faculty and hospital
administrations. As noted by the program director, this project has already brought added value to
the resident learning and patient care. By informing the residents that USPs would be visiting them
in the ED, the residents seemed to perform at a higher level, not knowing which patients might be
evaluating their performance and what measures were being evaluated. One resident commented
that when he thought a patient was a USP, he washed his hands more frequently, thinking that hand
washing was the metric we were evaluating. A faculty member noted that when one resident thought
he had identified a USP, he seemed more empathic and professional when discussing the discharge
plan and follow-up care. Clearly, the patients also benefited from the study, as higher professional
standards, including stricter adherence to Joint Commission Safety Initiatives were being executed
by the residents to more patients, not only the USPs.
We must further analyze our USP results, debriefing tapes, and audio tapes to understand
what additional information we can learn about our residents’ skills using this innovative
methodology. The fact that our post-OSCE results did not fully match the residents’ USP
encounters further supports the need to perform larger USP studies with multiple cases in order to
better understand the degree to which OSCEs reflect real world skills. It is our hope that we can in
what ways OSCEs can predict real life performance in order to enable us as educators to use them
as efficient and effective tools to help learners become expert physicians.
With the ACGME recently placing greater importance on evaluation of patient outcomes
and its linkage to medical education, we believe that our project is representative of a new way to
assess real-time resident physician performance. As program evaluators working toward
enhancement of curricula that better meet patient needs, this project has contributed much to our
larger efforts. The data collected from these OSCEs have been incorporated into Database for
Research on Education Academic Medicine (DREAM), an initiative of our Research on Medical
Education Outcomes Unit (ROMEO), which enables long-term, longitudinal assessments of
participant performance both in residency and beyond. Further comparison of OSCE evaluations
with USP encounters will enable educators to determine whether or not these commonly used
evaluation tools actually mimic real practice. The current OSCE data will be assessed in conjunction
with future evaluations and patient outcomes. We eagerly await results of a larger trial.
Lastly, this collaboration between NYUSOM Primary Care and Emergency Medicine has
enabled us to further heighten the overall abilities of NYUSOM faculty to teach and communicate
with each other and to our residents. Additionally, we believe this curriculum also provided an added
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Final Report) Page 15
PI: Sondra Zabar, MD
NYU School of Medicine
17. value as a faculty development opportunity. Faculty members in the Emergency Department have
gained a standardized approach to teaching and assessing communications skills after participating
or playing facilitative roles in the curriculum.
F. DISSEMINATION
We have already begun to share our methods with other departments and institutions.
Owing to the success of the EMPACT OSCE, the Gastroenterology fellowship used our cases for
their OSCE held on October 6, 2007. Their use of our communication skills checklist will enable us
to compare performance across disciplines and levels of training. They are planning a second OSCE
for additional fellows in May 2008. Additionally, current plans are under way within the Department
of Emergency Medicine at Johns Hopkins to apply for funding to support the use of USPs in
evaluation of curriculum focusing on disaster education.
In terms of publication, the Arnold P. Gold Foundation, which promotes and affirms more
compassionate medical care and caregivers, accepted our abstract (“A Curriculum in Patient-
Centeredness for Surgery and Emergency Medicine Residents: Establishing the Baseline.” M.
Hochberg, S. Zabar, L. Regan, R. Laponis, R. Richter, A.L. Kalet), for presentation at the Gold
Foundation Symposium, How Are We Teaching Humanism in Medicine and What is Working?,
which was held on September 27-29, 2007, Chicago, IL. Future plans include submission to
Academic Emergency Medicine, the journal of the Society of Academic Emergency Medicine as well
as to the national Council of Residency Directors (CORD) meeting for Emergency Medicine which
is held annually.
G. FINANCIAL REPORT
The Financial Report will be provided by the NYUSOM Sponsored Programs
Administration under separate cover.
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NYU School of Medicine
18. H. ATTACHMENTS
a. Sample Case and Checklist
b. Sample Report Card
c. Session Objectives
d. Sample Pocket Card
e. Sample Feedback
f. Dissemination
i. Gold Foundation Abstract
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NYU School of Medicine
19. Attachment – Sample Case and Checklist (Medical Error)
STATION OVERVIEW
OBJECTIVES To test the resident’s ability to:
1. Admit an error has been made
2. Be empathic
3. Address patient concerns surrounding an error
LOGISTICS Personnel: Standardized patient, male,
32 y.o., dressed in regular
clothing, sitting in chair.
Station Materials: • Resident instructions
• SP Instructions
• SP evaluation forms
• Faculty evaluation forms
Room Arrangement: • Station signs
• Chair (2)
• Exam table
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NYU School of Medicine
20. RESIDENT INSTRUCTIONS
PATIENT Name: John McCoy
INFORMATION Age: 32
REASON FOR
ENCOUNTER • John McCoy came to the ER 2 days ago complaining of
right wrist pain after falling while rollerblading near
Washington Square Park.
• At that time, his hand x-ray was MISREAD by a
resident as normal and he was sent home with an Ace
bandage and some ibuprofen.
• The Radiology Attending re-read the x-ray and found a
non-displaced, non-intra-articular right distal radius
fracture.
• He presents today to the ER after having been called
back.
YOUR ROLE ER Resident
YOUR TASKS 1) See the patient, explain what has occurred, and
develop a plan.
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NYU School of Medicine
21. STANDARDIZED PATIENT INSTRUCTIONS
THE SCENARIO Your name is John McCoy and you are 32 years old. 2 days ago you
were rollerblading in Washington Square Park prior to when your
shift started for work at a restaurant (you work as a waiter at the
Union Square Cafe). You fell and hit your outstretched right hand on
the pavement. Your right wrist hurt a lot and you were afraid that it
might have been broken. This was particularly concerning as you
work as a jazz pianist occasionally. You went to the Emergency
Room and after waiting for 4 hours, finally saw a doctor. They took
some x-rays and told you it was just a sprain. You got some pain
drugs (ibuprofen) and a bandage to wrap your wrist. You were told to
rest your wrist, use ice, and keep it wrapped and raised as much as
possible. Because of the wait at the ER, you had to have someone
cover for you at work.
Because you don’t get sick pay, you decided to work yesterday even
though you were in pain. This morning, you got a call from a nurse
instructing you to return to the ER as the doctors had some
information about your wrist. You again got someone to cover for
you (although you still won’t get paid) in order to go back to the ER
today. Today, the pain in your right wrist is about 5/10 (10 being the
worst pain in your life) and it only gets worse when you bend it back
or press on it. The swelling has gone down from 2 days ago and it
seems like it is slowly getting better, despite having used it yesterday
at work.
CHARACTER Objective: • To understand what has occurred and know when
DESCIRPTION you can return to work
Obstacles: • You are upset about missing work as you are
having a tough time making ends meet.
Tactics: You are initially somewhat agitated as you are
missing work again
When you hear the news of the mistake you become
further agitated
If the resident is empathic, apologizes, and is
helpful, you calm down a little.
If, however, the resident is at all defensive,
argumentative or unhelpful, then your agitation
continues to increase.
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NYU School of Medicine
22. SINCE YOU Since you left the ER 2 days ago, you have been trying to do what the
LEFT THE ER doctor told you to do: rest it, use ice, compress it with the bandage
and keep it elevated. You did, however, go to work yesterday after
taking a few ibuprofen (Advil) tablets and a strong gin and tonic in
order to minimize the pain. You got thru your shift without too much
trouble and were able to compensate using your left hand more often
than usual. Today, you still have some pain, but the ibuprofen is
helping.
PERSONALITY You tend to be a little dramatic. When you are happy, you border on
gushy and when you are upset, you can get angry. This is partly due
to the fact that your financial situation is slightly unstable and it can
put you on edge at times.
CURRENT LIFE You live with a roommate in the East Village.
SITUATION You have no children.
You work as a waiter at the Union Square Cafe and play jazz piano
intermittently with various local groups. You are still hoping to make
it as a pianist, but it hasn’t worked out that well so far.
PAST MEDICAL None. You are otherwise very healthy and active.
AND SURGICAL
HISTORY
FAMILY Your mother and father are both living in Ohio. They are healthy as
HISTORY far as you know. You have one brother who is healthy and married
living in Ohio as well.
SOCIAL You smoke ½ pack a day for the past 10 years.
HISTORY You drink alcohol at least 3 times per week, usually having 2-3 drinks
each time.
You do not use recreational drugs.
You are sexually active with a girlfriend you have had for the past 6
months. You use condoms for protection.
You are eating and sleeping well and staying active by rollerblading
and going to the gym occasionally.
MEDICATIONS Ibuprofen (Advil) – 2 tablets every 4 hours for pain
ALLERGIES None
THE When the Resident knocks and enters the room, you are sitting in a
ENCOUNTER chair in the exam room talking with a colleague trying to get someone
to cover for you as you are missing work. You are upset interrupting
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NYU School of Medicine
23. the person on the other end of the phone line and end the conversation
about 20-25 seconds after the resident enters the room. When you
hang up, you are still upset having had to miss work for the second
time this week. You show this by making eye contact with the
resident, occasionally breathing deeply and audibly, and have
aggravated tone to your voice.
You are testy and confrontational the entire interview and
occasionally interrupt the resident to voice your frustration.
If asked in an open-ended way why you are here, state: “You guys
called me. I was here a couple days ago about my wrist, so I assume
it’s about that.”
With respect to your wrist-
Any pain? – “A little, but the Advil helps.”
How bad is the pain? – “About 5 out of 10”
Any pain with movement? – “Only when I bend it back”
Any swelling? – “It’s gotten a lot better.”
Any tingling or loss of sensation? – “No”
Any redness? – “No”
Any tenderness? – “It hurts a little when I push on it.”
In general currently:
How have you been? – “Fine, I guess. My wrist hurt a bit during
work yesterday, but I got through it. But I’ve missed two days
because of this stupid thing.”
If/when you are told a mistake was made (i.e. someone read the x-ray
of your wrist incorrectly and you actually have a bone fracture)
regardless of where it occurs in the interview, take a moment to let it
set in and then at first become upset. Raise your voice, but do not
shout, look the Resident straight in the eye, and impatiently tap your
finger on the desk or table to underline your frustration. State:
“So my wrist is broken?”
“This is so annoying.”
“I mean, what’s going on here? I had to miss two days of work
because of this.”
If then the Resident acknowledges the mistake, states that
he/she is sorry that it happened/empathizes, you still remain
angry and state in a slightly aggressive tone:
“Oh man. I knew it. I knew it was something bad. This
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NYU School of Medicine
24. always happens to me. Well, will there be any long-term
damage?”
When you realize the long term damage will be nil or
minimal, you are only a little relieved. State in a somewhat
frustrated way:
“Why did this happen? What if this was something really
serious? I mean, my God, does this happen all the time?”
Whatever the resident’s response is state: “Well, don’t you think
this is a bad system here?”
If the Resident remains apologetic and non-confrontational, you
calm down a little and ask:
“Well, when can I go back to work?”
If the Resident acknowledges that a mistake was made, but then
becomes defensive, does not empathize or say he/she is sorry,
or makes up a bizarre story -> get more upset:
“I mean, me missing work today would have been totally
unnecessary right? If you guys actually did your job, I
wouldn’t have had to come down here.”
“I knew I shouldn’t have come to his ER.”
If the resident asks if they can write you a note, state sarcastically: “A
note? What I am I going to do with a note?”
Whenever the Resident changes course and becomes more
apologetic/empathic, react accordingly. Adequately challenge the
resident. You are upset for a multitude of reasons: losing work pay,
being in pain, losing faith in your health care provider, and not being
able to play piano. If you feel the resident is making a genuine effort
to address your concerns, is empathic and non-confrontational,
become less angry, but maintain a baseline of annoyance and
frustration. If the resident ever becomes dismissive/confrontational or
you don’t feel supported, become more upset.
Towards the end of the interview, regardless of the Resident’s
reactions, become calm. Your motivation for doing this is as
follows: If the Resident has admitted the mistake and acted
appropriately, you are satisfied. If the Resident has done poorly by not
admitting the mistake or making fabrications you become withdrawn
contemplating a lawsuit: (Please note: Do not mention lawsuit,
litigation, suing, or anything relating to malpractice unless the
Resident brings it up - this is purely an internal cue for you to help
you act out the character). If the latter is the case – partially cross
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NYU School of Medicine
25. your arms, rest your head on one hand, and avoid eye contact.
Once you have calmed down a little, state: “Well, I came all the way
down here. Now what?”
CHALLENGES • Admit that an error was made
FOR THE
• Regain patient trust
RESIDENT
CUES FOR THE Non-verbal 1 At the beginning of the interview, eye contact
RESIDENT with occasional audible breathing.
Verbal 2: State: Why exactly was I called back? ->
Resident to verbally acknowledge your concern
and explain reason
Verbal-Non- Express anger (state that you are upset, raise
Verbal 3: your voice, look at the Resident in angry and
accusatory fashion, underline your verbal
comment with tapping your fingers on the table)
-> Resident to verbally acknowledge your
anger/being upset and label it as understandable
Verbal-Non- Calm down in last part of encounter; if Resident
Verbal 4: acted appropriately: calm down (e.g., appear
more relaxed in your posture and voice); if
Resident acted inappropriately: withdraw (e.g.,
cross arms, speak in short sentences, etc). State:
“Well, I’m here. What do we do now?”
TIMING Initially: You are already a little upset.
Ongoing: If the Resident is empathic/truthful/straightforward,
become more and more calm. If the Resident is
defensive/evasive/making up bizarre stories, become more and more
upset.
2 minute warning: Begin to calm down because the Resident is
acting appropriately or withdraw because the Resident is acting
inappropriately. State: “What do we do now?”
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PI: Sondra Zabar, MD
NYU School of Medicine
26. Evaluator’s Checklist
COMMUNICATION Not Done Partially Done Well Done
Information Gathering
Elicited your responses using appropriate Impeded story by asking
Used leading/judgmental Asked questions one at a time
questions: leading/judgmental questions
questions OR asked more than without leading patient in their
AND more than one question at
one question at a time responses
No leading questions a time
Only one question at a time
Clarified information by repeating to Did not clarify (did not repeat Repeated information you Repeated information and
make sure he/she understood you on an back to you the information you provided but did not give you a directly invited you to indicate
provided) chance to indicate if accurate whether accurate
ongoing basis
Did not interrupt directly BUT cut
Did not interrupt AND allowed
Allowed you to talk without interrupting Interrupted responses short by not giving
time to express thoughts fully
enough time
Relationship Development
Communicated concern or intention to Did not communicate intention to
Words OR actions conveyed Actions AND words conveyed
help/concern via words or
help intention to help/concern intention to help/concern
actions
Non-verbal behavior enriched Non-verbal behavior was
Non-verbal behavior Non-verbal behavior facilitated
negative OR interfered with
communication (e.g., eye contact, posture) demonstrated attentiveness effective communication
communication
Acknowledged emotions/feelings Acknowledged & responded to
DID NOT acknowledge
Acknowledged emotions/feelings emotions/feelings in ways that
appropriately emotions/feelings
made you feel better
Made comments and
Made judgmental comments OR Did not express judgment but did
Was accepting/non-judgmental facial expressions not demonstrate respect
expressions that demonstrated
respect
Used words you understood and/or Consistently used jargon Sometimes used jargon AND did Explained jargon when used, OR
explained jargon WITHOUT further explanation not explain it avoided jargon completely
Education and Counseling
Asked questions to see what you Asked if patient had any Assessed understanding by
Did not check for understanding questions BUT did not check for checking in throughout the
understood understanding encounter
Gave confusing OR no
Information was somewhat clear Provided small bits of information
explanations which made it
Provided clear explanations/information impossible to understand
BUT still led to some difficulty in at a time AND summarized to
understanding ensure understanding
information
Collaborated with you in identifying Told patient options, THEN
Told patient next steps THEN
Told patient next steps/plan mutually developed a plan of
possible next steps/plan asked patient’s views
action
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PI: Sondra Zabar, MD
NYU School of Medicine
27. ADDRESSING MEDICAL ERROR
Accountability
Disclosed error
Did not directly disclose the error
• Direct (used the words “error” or Did not directly disclose the error
(there was a “problem”) NOR
(there was a “problem”) OR
Directly disclosed the error upfront
“mistake”) directly disclosed late in the
was the explanation upfront
interview
• Prompt disclosure
Personally apologized for the error (“I am Did not apologize for error NOR
Apologized for the error OR for Apologized for the error AND for
for the inconvenience it caused
sorry that this happened) the inconvenience it caused you the inconvenience it caused you
you
Shared the cause of the error (i.e., Acknowledged issue with system
Did not acknowledge issues with Acknowledged issue with system
BUT was dismissive/
Explained issues with system) system AND was genuine in addressing it
condescending
Took no personal responsibility
Took a general responsibility as
for your present situation (e.g., Took a personal responsibility for
Took responsibility for situation assigns your problem to other
part of the department for your
your situation (“I will…)
present situation
person/department)
Made general suggestion for
Identified future preventative strategies Did not address how situation improvement (e.g., “We’ll look Offered specific strategies for
to prevent situation from happening again would be prevented in future into it,” “I’ll make a note of it to potential improvement of system
my Attending”)
Managing a Difficult Situation
Became defensive/ Became defensive/
Remained calm AND did not
Avoided assigning blame argumentative AND assigned argumentative OR assigned
mention blame someone else
blame to a person/department blame to a person/department
Maintained a high level of
Maintained professionalism by Unable to control emotions, Attempted to control emotions
professionalism in handling your
became dismissive and (e.g. was somewhat dismissive
controlling emotions specific situation, did not show
condescending or condescending)
anger or frustration
Delivering Bad News
Prepared you to receive the news: Entered room in a manner
Entered room in a manner Entered room in a manner befitting
unfitting the news AND
• Entered room prepared to deliver news physically situated him/herself
unfitting the news OR physically the news AND physically situated
situated him/herself far from you him/herself close to you
• Ensured sufficient time and privacy far from you
Assessed your readiness to receive news: Attempted to deliver warning
shot, BUT inappropriately (does Gave you a well-timed warning
• Gave warning shot (e.g., “I have No warning shot
not pause for your assent OR shot
some good and bad news for you…”) warning shot too long)
Gave you opportunity to emotionally
respond: Responded inappropriately to Allowed you to emotionally Allowed you to express your
your emotional reaction (no respond (vent) BUT did not feelings, fully giving you the feeling
• Remained sensitive to your venting of opportunity to vent, cut you off, address/acknowledge response you were being listened to before
shock/anger/disbelief/accusations became defensive) before moving on moving on
• Attended to emotions before moving on
Acknowledged your feelings
Directly asked what you are feeling: “What (e.g., “I see that you are
Did not ask specifically “What Specifically asked you “What are
upset…”) BUT did not
are you thinking/feeling?” are you thinking/feeling?” you thinking/feeling?”
specifically ask you to name your
emotions
Offered specific next steps (e.g.
Provided appropriate “next steps” Did not offer next steps AND
Offered only general next steps
Orthopedics is going to fit you for a
(e.g., I’ll be calling Ortho) OR
• Orthopedics for immediate care evaded response as to what will
promised to “ask the attending”
cast) AND informed you of long
happen long-term term care needs (e.g., unable to
• What to expect long-term for next steps
use arm for 6 weeks)
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NYU School of Medicine
28. Would you recommend this doctor to a friend for his/her interpersonal skills?
Recommend with
Not Recommend Recommend Highly Recommend
Reservation
Would you recommend this doctor to a friend for his/her medical competence?
Not Recommend Recommend with Recommend Satisfactory Highly Recommend
Non -exemplary Physician: Reservation Unexceptional Physician: Model Physician:
superficial, artificial demeanor applied appropriate knowledge base applied sophisticated, wise, thoughtful, applied
Physician:
knowledge base inadequate to my adequately to my specific situation profound knowledge base specifically to
awkward, knowledge base only
situation my situation
somewhat apparent in application to my
situation
COMMENTS:
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NYU School of Medicine
29. Attachment – Sample Report Card
EMPACT
OSCE Report of Results – July 2007
Clinical skills were assessed in 5 cases. Your scores in 5 core areas – communication scores, overall
recommendation scores, ratings of ability to apply expertise, specific skills across cases, and overall case-
specific skill scores -- are reported in the charts that follow. For case-specific skills and recommendation
ratings, results for each case are included as well. One case was not reliably scored (Unexpected Death) and
so scores associated with that case should be interpreted with caution.
Overall communication score: Calculated across all cases as the % of behaviorally-anchored
communication items (8-14 items per case) for which you were rated as having performed well (“done
well”). Sub-domains include: Information gathering, relationship development, and patient education.
Overall recommendation rating: Calculated across all cases on the basis of rating of degree to which
“would recommend physician to a friend based on his/her communication skills” with the following response
options: Not Recommend – Recommend with Reservations – Recommend – Highly Recommend.
Overall rating of application of expertise: Calculated across all cases on the basis of rating of degree to
which applied expertise effectively, using a 4-pt scale: Insufficient Application, Slight Application, Sufficient
Application, Exceptional Application of Expertise.
Selected skills across cases: Calculated as the % of items rated as well done for specific skills
measured across at least several cases including: delivering bad news, managing difficult situations,
accountability, handling emotions.
Overall case-specific skills: Calculated across all cases as the % of items rated as well done for core
knowledge and skill items specific to each case.
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NYU School of Medicine
30. Communication Scores for Sample Student
100%
Error Bars: +/- 1 Std Dev
Your Scores Class Mean
90%
80%
70%
64%
61%
60% 56%
% Well Done
51% 50% 52%
50%
40%
33%
30% 27%
20%
10%
0%
OVERALL Communication - Communication - Communication - Patient
COMMUNICATION SCORE Information Gathering Relationship Development Education
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Progress Report) Page 29
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NYU School of Medicine
31. Overall Recommendation Rating for Sample Student
Highly 4 Error Bars: +/- 1 Std Dev
Recommend
3.35
Recommend
3
Informed Consent
2.75
X-Ray Recall
Unexpected Death*
Transfer of Care
Recommend
with 2
Reservation
Not 1 Repeat Visit
Recommend OVERALL Recommendation Ratings
RECOMMENDATION for Each Case *Unreliable Case -
Interpret w/ Caution
Your Scores Class Mean
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Progress Report) Page 30
PI: Sondra Zabar, MD
NYU School of Medicine
32. Overall Rating of Application of Expertise for Sample Student
Exceptional
Unexpected Death*
Application 4
Error Bars: +/- 1 Std Dev
of Expertise
Sufficient
Application
3 2.84
Informed Consent
Transfer of Care
Informed Consent
Transfer of Care
X-Ray Recall
Repeat Visit
X-Ray Recall
Repeat Visit
2.00
Slight
2
Application
of Expertise
Insufficient 1
Application OVERALL RATING Ratings
APPLICATION OF EXPERTISE for Each Case *Unreliable Case -
Interpret w/ Caution
Your Scores Class Mean
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Progress Report) Page 31
PI: Sondra Zabar, MD
NYU School of Medicine
33. Case-Specific Skills for Sample Student
100%
Error Bars: +/- 1 Std
90%
80%
70%
60%
Transfer of Care 86%
48% 49%
Informed Consent 70%
50%
Unexpected Death 64%*
40%
Repeat Visit 50%
30%
X-Ray Recall 67%
20%
10%
0%
OVERALL CASE-SPECIFIC Rating of Knowledge Skills
KNOWLEDGE SKILLS for Each Case *Unreliable Case -
Interpret w/ Caution
Your Scores Class Mean
EM RESIDENT TRAINING IN INTERPERSONAL AND PROFESSIONALISM SKILLS (Progress Report) Page 32
PI: Sondra Zabar, MD
NYU School of Medicine