title: Tough Conversations: Development of a Curriculum for Medical Students to Lead Family Meetings.
abstract: BACKGROUND
  Few educational interventions have been developed to teach Family Meeting (FM) communication skills at the undergraduate level. We developed an innovative curriculum to address this gap.
  
  
  METHODS
  Fourth year medical students during 2011-2013 (n = 674) completed training for conducting a FM. To assess the effectiveness of this training, students completed a FM Objective Structured Clinical Exam (OSCE) that included 15 domains rated on a 1-5 point Likert scale. Tasks included discussing prognosis, establishing goals of care and demonstrating conflict resolution skills. Students received one-to-one feedback from standardized family members and faculty observers. Group debriefings with faculty were held after the OSCE.
  
  
  RESULTS
  Analysis of faculty feedback narratives revealed four themes in which students required improvement: 1) Discussing prognosis, 2) Explaining palliative care/hospice, 3) Avoiding medical jargon, and 4) Discussing cultural/religious preferences. Evaluation total mean score was 28.2 (Min 15, Max 63; SD 7.57), and identified student's need to; 1) Ask more about the degree of knowledge family members want, 2) Ask religious beliefs, and 3) Assess family members' level of education ( p < 0.001). Qualitative analysis of group debriefings suggested that student perception of the OSCE experience was positive overall. Students found the case to be realistic and immediate feedback to be helpful.
  
  
  CONCLUSIONS
  Conducting a FM is an advanced skill. This study shows that it is possible to train fourth year students to lead FMs and identify their strengths, needs using a FM OSCE.
authors.affiliation: 1 Department of Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Hagiwara
authors.affiliation: 1 Department of Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.|2 Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.|3 Geriatric Research Education Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ross
authors.affiliation: 3 Geriatric Research Education Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA.
authors.forename: Shuko
authors.initials: S
authors.lastname: Lee
authors.affiliation: 2 Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.|3 Geriatric Research Education Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sanchez-Reilly
mesh_terms: D003142:Communication; D054521:Cultural Competency; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D004521:Educational Measurement; D004522:Educational Status; D005190:Family; D006126:Group Processes; D006801:Humans; D017008:Negotiating; D010166:Palliative Care / Q000458:organization & administration / Q000523:psychology; D010347:Patient Care Planning / Q000458:organization & administration*; D011379:Prognosis; D013337:Students, Medical / Q000523:psychology; D013727:Terminal Care / Q000458:organization & administration / Q000523:psychology
keywords: communication; family meetings; medical education; objective structured clinical exam; palliative care; undergraduate medical education