Ludwig Haw-Bair Lin*, University of California, San Francisco, San Francisco, United States Lindsey Huddleston, University of California, San Francisco, San Francisco, United States Jason Leong, Albert Einstein School of Medicine, New York, United States Erin Hennessey, Stanford University, Stanford, United States Track: Research Presentation Topic: Web 2.0-based medical education and learning Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2013-09-25

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Background
Critical illness is unplanned, and few physician trainees are adequately prepared for the essential communication between ICU providers and their patients/families. However, a literature review reveals the dissatisfaction of patients and families in their communication with physicians, specifically concerning ICU settings and end of life care. In a study by Curtis et al., 12 specific domains of physicians’ skills used in this setting were identified. Residents are at the frontline of patient care, but have no formal didactic program addressing the skills needs.
Methods
We performed a focused needs assessment, using a survey based on the 12 domains described by Curtis et al. with the addition of questions deemed appropriate to our specific resident and patient population. This survey was distributed to our learner audience. Responders answered questions regarding religion, spirituality, and cultural aspects of providing care using a likert-scale. All other topics were addressed using open ended questions.
Results
The survey results presented findings regarding residents’ perceptions on their ability to provide effective communication to patients/ families in the ICU. When asked what topic was important for discussing rehabilitation, disability or end of life care with patients/families, 54% of respondents’ answers were categorized to Education: Patient Outcomes. An overwhelming number or residents stated that Grief and Family Resistance were particularly difficult and intimidating. We have chosen these two topics as the focus of our curriculum in addressing communication skills.
Conclusion
Further education is necessary. As the next step, we are constructing an internet-based multi-media course, utilizing medical trainees’ comfort with social media and on-line social interactions in our efforts. We hypothesize that the course will improve house staff confidence in interpersonal interactions, with the projected outcome that taking the course will result in higher scores on our patient interaction vignette scenarios, as compared to control.
The modules focus on ICU outcomes and family grief. Topics in the ICU outcomes module include: prognosis tools, disabilities, DNR orders and end of life care. Topics included in the family grief module include: normal versus complicated grief, grief models, and treatment modalities. The topics will be taught using audiocasts, videocasts, and case-based scenarios, in an on-line and interactive manner; our plan is to stimulate forum-based conversations amongst the residents, which are triggered by video snippets of simulated communication scenarios involving them and patients/families. These forums will be moderated weekly by course instructors, but the webcasts will be posted to stimulate active blogging for flexible resident participation, an advantage given the restrictive resident work hours stipulations.
Pre- and post- tests will be used to assess the curriculum's effectiveness. The tests have two parts: clinical vignettes which prompt responses and decisions from the learner and allow the evaluation of learner judgment and knowledge gain, and a survey regarding the learners' perceived levels of confidence and stress. Ideally, we will establish that it leads to improved experiences for patients/families as a result of better communication and interactions with their physicians.
Ref: Curtis et al. J Gen Intern Med 2001;16:41-49.