Improving Communication Skills of Residents Using Family Meeting Simulation Exercises

Effective communication skills are important to deliver serious news. Applying Kolb's experiential learning theory, we evaluated the impact of a mini-lecture and simulation-based curriculum to improve communication skills and confidence of residents delivering bad news during a Medical Intensive Care Unit (MICU) rotation.

We performed an educational intervention for 26 internal medicine residents on their MICU rotation. Each resident first underwent a Mini-Clinical Evaluation Exercise (Mini-CEX) family meeting simulation with untrained actors, where they were observed and evaluated by two MICU attendings using a standardized modified SPIKES protocol evaluation tool. One week later, a 30-min PowerPoint interactive lecture on the SPIKES protocol was presented by a Chief Medical Resident. A post-didactic Mini-CEX was held 1 week after the lecture. Residents also completed a brief survey before and after the intervention to assess their level of comfort in conducting an effective family meeting.

Residents were more comfortable facilitating an end-of-life family meeting after the intervention (p < 0.001). Mini-CEX scores improved on all 20 SPIKES items (all p < 0.001), and there was a significant improvement in Mini-CEX sum scores (premean = 24.7 vs. postmean = 46.1, p < 0.001). Both International Medical Graduates (IMG) and US Medical Graduates (USMG) had significantly improved scores in each component of SPIKES.

We demonstrated that the experience of a simulated family meeting followed by a 30-min didactic on the SPIKES protocol and a post-didactic family meeting improved the skills and confidence of residents in leading family meeting discussions.