Patient-Centered Communication Case: Threatened Miscarriage

This communication case is intended for EM residents of all levels.

Patient-centered communication is a necessary skill in the practice of emergency medicine. This style of communication is crucial for promoting high-quality healthcare by prioritizing patient needs, perspectives, and values. This patient-centered communication case centers on miscarriage, a diagnosis where patient-centered communication is requisite. Approximately one in six or 17.1% of patients with a final diagnosis of miscarriage, also known as early pregnancy loss, present initially to the emergency department.1 Advising a patient of the diagnosis of miscarriage requires excellent communication skills including facile rapport building, empathy, nonverbal communication, and explanation of management options.

By the end of this certifying exam practice case, learners will be able to: 1) establish a supportive and compassionate environment through verbal and non-verbal communication when engaging with a patient experiencing distress, anxiety, or grief related to potential pregnancy loss, 2) actively explore the patient's understanding, concerns, values, and goals related to their pregnancy and presenting symptoms, 3) recognize and normalize a range of emotional reactions, offering validation and support regardless of the patient's obstetric history or desired pregnancy outcomes, 4) clearly explain the diagnosis of a "threatened miscarriage," outlining its clinical implications, inherent uncertainty, and potential outcomes, 5) review the results of any imaging or lab studies succinctly and empathetically, while verifying the patient's understanding, 6) collaborate with the patient to develop a mutually agreeable care plan, including medical recommendations, appropriate follow-up, monitoring, and return precautions.

This standardized patient case provides an opportunity to practice patient-centered communication and debrief on areas for improvement for the learner. The case was co-developed by experts in simulation-based education and emergency medicine resident leadership.

Facilitators evaluated the standardized patient case via a survey for efficacy, while learners evaluated it via a survey from the learner perspective. This case was tested in a serial fashion with incremental improvements based on feedback at each step: initially, both learners and facilitators at the case writer's institution, then learners and facilitators at the annual SAEM meeting, and finally with both at an institution outside of the case writer's institution. Three unique learners and three unique facilitators tested the case throughout the entire process.

The case was reviewed favorably with minor recommendations noted, such as additional notes for the facilitator and stronger alignment between objectives and critical actions expected. Both surveys asked for demographic information and an evaluation of the case on a scale of 1-5, with 5 being the highest rating. Learners ranked the case 4.5, and then 4.8 on iterative trialing sessions. Facilitators ranked the case above 4 out of 5 for all questions. Comments centered on clarifying verbal prompts and debriefing plan.

Overall, this standardized patient case for patient communication was received positively and is recommended for use in preparation for the ABEM certifying examination.

Patient-centered communication, threatened miscarriage, health communication.