Using Implementation Science to Adapt a Training Program to Assist Surgeons with High-Stakes Communication
| Autor: | Joshua Hauser, Amy Zelenski, Jennifer L. Tucholka, Sarah H. Adkins, Lauren J. Taylor, Sara K. Johnson, Margaret L. Schwarze, Gordon Wood, Toby C. Campbell, Wendy G. Anderson, Carolina R Branson, Pasithorn A. Suwanabol, Steven J. Skube, Andrew W. Hoel |
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| Rok vydání: | 2019 |
| Předmět: |
Computer science
media_common.quotation_subject education Instructional video Fidelity Specialties Surgical Education 03 medical and health sciences 0302 clinical medicine business.product_line 030212 general & internal medicine Competence (human resources) Implementation Science media_common Physician-Patient Relations Medical education Communication Attendance Resident education Communication skills training Checklist 030220 oncology & carcinogenesis Feasibility Studies Surgery Curriculum business Training program |
| Zdroj: | Journal of Surgical Education. 76:165-173 |
| ISSN: | 1931-7204 |
| DOI: | 10.1016/j.jsurg.2018.05.015 |
| Popis: | Objective Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity. Design, setting, and participants We used the Replicating Effectiveness Programs framework to guide our implementation strategy and tested our intervention with 39 surgical residents at 4 institutions from September 2016 to June 2017. The implementation package consisted of: (1) instructional video, (2) checklist to assess competence, (3) learner manual, and (4) instructor manual. We focused on 3 implementation outcomes: feasibility, fidelity, and acceptability to participants. Results Attendance rates ranged from 16% to 75%. Site leaders had little difficulty identifying suitable instructors; however, resident recruitment proved challenging. Sixty-nine percent of residents completed the post-training assessment and the mean score was 12.8 (range 8-15) using the 15-point checklist. Across sites, 69% strongly agreed that Best Case/Worst Case is better than how they usually approach high-stakes conversations and 100% felt prepared to use the tool after training. Instructors reported that the training provided residents with the necessary skills to perform the fundamental elements of Best Case/Worst Case. Conclusions Using implementation science we demonstrated that a resource intensive communication training intervention can be successfully modified for group-learning and wide-scale dissemination. However, we identified barriers to implementation, including challenges with feasibility and programmatic buy-in that inform not only resident education but also communication skills training more broadly. |
| Databáze: | OpenAIRE |
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