title: A Nephrology Fellows' Communication Skills Course: An Educational Quality Improvement Report.
abstract: Nephrology fellows need expertise navigating challenging conversations with patients throughout the course of advanced kidney disease. However, evidence shows that nephrologists receive inadequate training in this area. This study assessed the effectiveness of an educational quality improvement intervention designed to enhance fellows' communication with patients who have advanced kidney disease.
  
  
  
  Quality improvement project.
  
  
  
  Full-day annual workshops (2013-2014) using didactics, discussion, and practice with simulated patients. Content focused on delivering bad news, acknowledging emotion, discussing care goals in dialysis decision making when prognosis is uncertain, and addressing dialysis therapy withdrawal and end of life. Participants were first-year nephrology fellows from 2 Harvard-affiliated training programs (N=26).
  
  
  
  Study assessed the effectiveness of an intervention designed to enhance fellows' communication skills.
  
  
  
  Primary outcomes were changes in self-reported patient communication skills, attitudes, and behaviors related to discussing disease progression, prognostic uncertainty, dialysis therapy withdrawal, treatments not indicated, and end of life; responding to emotion; eliciting patient goals and values; and incorporating patient goals into recommendations.
  
  
  
  Surveys measured prior training, pre- and postcourse perceived changes in skills and values, and reported longer term (3-month) changes in communication behaviors, using both closed- and open-ended items.
  
  
  
  Response rates were 100% (pre- and postsurveys) and 68% (follow-up). Participants reported improvement in all domains, with an overall mean increase of 1.1 (summed average scores: precourse, 2.8; postcourse, 3.9 [1-5 scale; 5 = "extremely well prepared"]; P<0.001), with improvement sustained at 3 months. Participants reported meaningful changes integrating into practice specific skills taught, such as "Ask-Tell-Ask" and using open-ended questions.
  
  
  
  Self-reported data may overestimate actual changes; small sample size and the programs' affiliation with a single medical school may limit generalizability.
  
  
  
  A day-long course addressing nephrology fellows' communication competencies across the full course of patients' illness experience can enhance fellows' self-reported skills and practices.
authors.affiliation: Nephrology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: rcohen@bidmc.harvard.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cohen
authors.affiliation: Palliative Care Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Jackson
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Diana
authors.initials: D
authors.lastname: Norwich
authors.affiliation: Section of Palliative Care and Medical Ethics and Renal Division-Electrolyte Division, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Jane O
authors.initials: JO
authors.lastname: Schell
authors.affiliation: Division of Psychosocial Medicine and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Schaefer
authors.affiliation: Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Amy N
authors.initials: AN
authors.lastname: Ship
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D003142:Communication; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000193:education*; D010817:Physician-Patient Relations; D011446:Prospective Studies; D058996:Quality Improvement
keywords: Communication skills; conservative management; dialysis decision-making; dialysis withdrawal; end of life; kidney disease; nephrology fellows; patient-centered care; physician training; quality improvement