Utilizing Simulated Patients to Train Internal Medical Residents in Advanced Communication Skills

Lauren Zabel; Yuya Hagiwara

doi:10.1016/j.jpainsymman.2025.02.284

1. Participants will be able to describe the development, implementation and impact of a communication workshop for internal medicine trainees. 2. Participants will be able to recognize that educational interventions for palliative care communication skills are essential during residency training. Although Interpersonal and Communication Skills is a core ACGME competency, conducting a goals of care discussion is an advanced communication skill that is not always emphasized during residency training. To address this gap a workshop was developed to train internal medicine residents in advanced communication techniques using standard patient encounters. Internal medicine (IM) is a specialty that often requires providers to engage in challenging goals of care (GOC) discussions with patients who are facing serious illnesses. (1) Although Interpersonal and Communication Skills are core ACGME competencies, these skills are not always emphasized during training. (2) To address this gap, we developed a workshop using simulated patient encounters aimed at improving residents’ capability and skillset in this critical area. • Describe the development, implementation and impact of a communication workshop for internal medicine trainees. • Recognize that educational interventions for palliative care communication skills are essential during residency training. A 120-minute workshop was developed utilizing three simulated patient encounters. Each encounter was observed by a palliative care physician, allowing for immediate feedback and the highlighting of key learning points during a structured debriefing. A total of 46 IM residents participated during the 2023-2024 academic year. The evaluation included a pre- and postworkshop self-assessment survey. A total of 37/21 residents completed the pre/post workshop self-assessment. Before the workshop 89% of residents reported high to moderate comfort in breaking bad news and 86% felt similarly about discussing code status. After the workshop, while residents reported improved comfort in discussing certain topics, there was a reported decrease in perceived comfort with discussing code status (76%) and breaking bad news (76%). Qualitative feedback from the postworkshop data indicated an overall improvement in perceived competency. The workshop effectively improved residents' confidence in certain palliative care areas but also revealed a decrease in confidence for other topics. This decline may be due to an initial overestimation of comfort with these skills, which led to a reduced perception of comfort postworkshop. These findings highlight the need for continued, targeted training in advanced communication skills for internal medicine residents, even among those who initially feel confident. 1. Bernacki RE, Block SD; American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014 Dec;174(12):1994-2003. doi: 10.1001/jamainternmed.2014.5271. PMID: 25330167. 2. Eno, Celeste, et al. “Milestones Guidebook for Residents and Fellows.” Accreditation Council for Graduate Medical Education (ACGME), 2020.

Utilizing Simulated Patients to Train Internal Medical Residents in Advanced Communication Skills

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