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A Nephrology Fellows' Communication Skills Course: An Educational Quality Improvement Report.

Robert A Cohen1, Vicki A Jackson2, Diana Norwich3

  • 1Nephrology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|March 21, 2016
PubMed
Summary

Nephrology fellows improved communication skills with advanced kidney disease patients after a training workshop. The enhanced skills in discussing sensitive topics and patient goals were sustained at three months.

Keywords:
Communication skillsconservative managementdialysis decision-makingdialysis withdrawalend of lifekidney diseasenephrology fellowspatient-centered carephysician trainingquality improvement

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Area of Science:

  • Medical Education
  • Nephrology
  • Communication Skills Training

Background:

  • Nephrology fellows require advanced communication skills for challenging patient conversations in advanced kidney disease.
  • Current training for nephrologists in these essential communication skills is often inadequate.
  • This study evaluated an educational intervention to improve communication between fellows and patients with advanced kidney disease.

Purpose of the Study:

  • To assess the effectiveness of a quality improvement intervention aimed at enhancing communication skills of nephrology fellows.
  • To improve fellows' ability to discuss disease progression, prognostic uncertainty, and end-of-life care with patients.
  • To enhance fellows' skills in responding to patient emotions and eliciting/incorporating patient goals into care recommendations.

Main Methods:

  • A quality improvement project involving a full-day workshop for first-year nephrology fellows (N=26) from two Harvard-affiliated programs.
  • The workshop utilized didactics, discussion, and simulated patient encounters focusing on critical communication scenarios.
  • Pre- and post-workshop surveys, along with a 3-month follow-up survey, measured self-reported changes in communication skills, attitudes, and behaviors.

Main Results:

  • Participants reported significant improvements across all assessed communication domains (mean increase of 1.1 on a 1-5 scale; P<0.001).
  • Self-reported skill enhancement was sustained at the 3-month follow-up.
  • Fellows successfully integrated specific communication techniques, such as "Ask-Tell-Ask" and open-ended questions, into their practice.

Conclusions:

  • A comprehensive, day-long communication skills training program can effectively enhance self-reported competencies for nephrology fellows.
  • The intervention improved fellows' ability to navigate complex patient communication throughout the illness trajectory.
  • The findings suggest that targeted educational interventions can positively impact communication practices in nephrology training.