title: Improving Resident Communication in the Intensive Care Unit. The Proceduralization of Physician Communication with Patients and Their Surrogates.
abstract: Effective communication between providers and patients and their surrogates in the intensive care unit (ICU) is crucial for delivery of high-quality care. Despite the identification of communication as a key education focus by the American Board of Internal Medicine, little emphasis is placed on teaching trainees how to effectively communicate in the ICU. Data are conflicting on the best way to teach residents, and institutions vary on their emphasis of communication as a key skill. There needs to be a cultural shift surrounding the education of medical residents in the ICU: communication must be treated with the same emphasis, precision, and importance as placing a central venous catheter in the ICU. We propose that high-stakes communications between physicians and patients or their surrogates must be viewed as a medical procedure that can be taught, assessed, and quality controlled. Medical residents require training, observation, and feedback in specific communication skill sets with the goal of achieving mastery. It is only through supervised training, practice in real time, observation, and feedback that medical residents can become skillful practitioners of communication in the ICU.
authors.affiliation: 1 Department of Medicine and.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: 2 Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.|3 Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; and.
authors.forename: Jakob I
authors.initials: JI
authors.lastname: McSparron
authors.affiliation: 4 Departments of Medicine and Medical Education, Mount Auburn Hospital, Cambridge, Massachusetts and Harvard Medical School, Boston, Massachusetts.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Clardy
authors.affiliation: 2 Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.|3 Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; and.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Sullivan
authors.affiliation: 2 Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.|3 Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; and.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Hayes
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D004521:Educational Measurement; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D014481:United States
keywords: communication; critical care; medical education