Difficult conversations: a national course for neurosurgery residents in physician-patient communication

To describe the design, content, implementation, and evaluation of a national curriculum for teaching practical skills in empathic communication to residents in neurosurgery.

Based on needs assessed through a national survey of neurosurgery program directors, videotaped scenarios using standardized patients illustrating good and bad communication skills were developed. Presurveys and postsurveys were conducted querying participants on their level of competence and the specific behaviors they would attempt to change following participation. A subgroup of residents was evaluated before and after the training based on videotaped role-play exercises.

A pilot study was conducted at the authors' institution and later implemented at National Neurosurgery Boot Camps.

A total of 14 Duke graduate medical education neurosurgery residents agreed to participate in the pilot study. From across the country, 93 residents (representing 59 institutions) participated in the communication training as part of the Neurosurgery Boot camps, 11 of whom volunteered to participate in a role-playing session before and after the formal teaching session.

Most of the neurosurgery program directors responding to the survey indicated that an interactive online communication-training module would be of value (77%). A total of 93 residents participated in communication training as part of the Neurosurgery Boot Camps. Approximately half of the residents reported having no formal physician-patient communication training. Presurvey and postsurvey results showed significant improvement in several of the communication scenarios. Those who participated in role-play showed significant improvement in "asking open-ended questions," "listening," "fire warning shot," "allowing patient to absorb," and "explaining in clear language."

Neurosurgeons frequently participate in difficult conversations. Both residents and faculty note that exposure to this content is suboptimal. A hybrid approach to teaching communication skills is well received and enhances graduate medical education training of surgical subspecialists.